Annals of Surgical Oncology

, Volume 21, Issue 2, pp 401–407 | Cite as

Bone Marrow Micrometastases Do Not Impact Disease-Free and Overall Survival in Early Stage Sentinel Lymph Node–Negative Breast Cancer Patients

  • Igor Langer
  • Ulrich Guller
  • Mathias Worni
  • Gilles Berclaz
  • Gad Singer
  • Gabriel Schaer
  • Mathias K. Fehr
  • Thomas Hess
  • Carsten Viehl
  • Lucio Bronz
  • Beate Schnarwyler
  • Edward Wight
  • Eduard Infanger
  • Daniel Burger
  • Ossi R. Koechli
  • Markus Zuber
  • for the Swiss Multicenter Sentinel Lymph Node Study Group in Breast Cancer
Breast Oncology



The presence of lymph node metastases is the most important prognostic factor in early stage breast cancer. Whether bone marrow micrometastases (BMM) impact the prognosis in sentinel lymph node (SLN)–negative breast cancer patients remains a matter of debate. Therefore, the objective of this study was to assess the impact of BMM on 5-year disease-free and overall survival among those patients.


We analyzed 410 patients with early stage breast cancer (pT1 and pT2 ≤ 3 cm, cN0) who were prospectively enrolled into the Swiss Multicenter Sentinel Lymph Node Study in Breast Cancer between January 2000 and December 2003. All patients underwent bone marrow aspiration followed by SLN biopsy. All SLN were stained with hematoxylin and eosin and immunohistochemistry (Lu-5, CK-22). Cancer cells in the bone marrow were identified after staining with monoclonal antibodies A45-B/B3 against CK-8, -18, and -19.


Negative SLN were found in 67.6 % (277 of 410) of the enrolled patients. Of those, BMM status was negative in 75.8 % (210 of 277) and positive in 24.2 % (67 of 277) patients. Median follow-up was 61 (range 11–96) months. Five-year disease-free survival was 93.6 % (95 % confidence interval [CI] 89.1–96.0) in BMM-negative and 92.2 % (95 % CI 82.5–96.2) in BMM-positive patients (p = 0.50). Five-year overall survival was 92.7 % (95 % CI 87.9–95.8) for the BMM-negative and 92.5 % (95 % CI 83.4–96.2) for the BMM-positive group (p = 0.85).


This is one of the first prospective studies to examine 5-year disease-free and overall survivals in SLN-negative patients in correlation to their BMM status. Although BMM are identified in one of four SLN-negative patients, they do not impact disease-free and overall survival.


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Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Igor Langer
    • 1
  • Ulrich Guller
    • 2
    • 3
  • Mathias Worni
    • 3
  • Gilles Berclaz
    • 4
  • Gad Singer
    • 5
  • Gabriel Schaer
    • 6
  • Mathias K. Fehr
    • 7
  • Thomas Hess
    • 8
  • Carsten Viehl
    • 9
  • Lucio Bronz
    • 10
  • Beate Schnarwyler
    • 11
  • Edward Wight
    • 12
  • Eduard Infanger
    • 13
  • Daniel Burger
    • 14
  • Ossi R. Koechli
    • 15
  • Markus Zuber
    • 16
  • for the Swiss Multicenter Sentinel Lymph Node Study Group in Breast Cancer
  1. 1.Department of SurgeryLindenhof HospitalBerneSwitzerland
  2. 2.Division of Medical Oncology and HematologyKantonsspital St. GallenSt. GallenSwitzerland
  3. 3.Department of SurgeryUniversity Hospital BerneBerneSwitzerland
  4. 4.Division of GynecologyEngeriedspitalBerneSwitzerland
  5. 5.Institute of PathologyKantonsspital BadenBadenSwitzerland
  6. 6.Department of Obstetrics and GynecologyKantonsspital AarauAarauSwitzerland
  7. 7.Division of GynecologyKantonsspital FrauenfeldFrauenfeldSwitzerland
  8. 8.Division of GynecologyKantonsspital WinterthurWinterthurSwitzerland
  9. 9.Department of SurgeryUniversity Hospital BaselBaselSwitzerland
  10. 10.Department of Obstetrics and GynecologyOspedale San GiovanniBellinzonaSwitzerland
  11. 11.Private PracticeZurichSwitzerland
  12. 12.Division of GynecologyUniversity Hospital BaselBaselSwitzerland
  13. 13.Department of Obstetrics and GynecologyKantonales Spital Sursee-WolhusenSurseeSwitzerland
  14. 14.Department of Obstetrics and GynecologyHospital LachenLachenSwitzerland
  15. 15.Bethanien ClinicZurichSwitzerland
  16. 16.Department of SurgeryKantonsspital OltenOltenSwitzerland

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