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Clinical Implications of Occult Metastases and Isolated Tumor Cells in Sentinel and Non-Sentinel Lymph Nodes in Early Breast Cancer Patients: Serial Step Section Analysis with Long-Term Follow-Up

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

This study was designed to clarify retrospectively the clinical significance of occult metastases in both sentinel lymph nodes (SLNs) and non-SLNs in patients with early breast cancer.

Methods

A total of 109 (80.1%) of 136 women with breast cancer who had consecutively undergone SLN biopsy (176 lymph nodes) were intraoperatively diagnosed as being free of SLN involvement. SLNs were routinely examined by hematoxylin–eosin (HE) staining of one to four frozen sections per node. Sixty-four (58.7%) of these patients also underwent backup axillary dissection. For the 109 patients, all formalin-fixed, paraffin-embedded tissues of SLNs and non-SLNs were entirely cut into 5-μm-thick sections. All serial step sections at 85-μm intervals were stained with HE and immunohistochemistry with pancytokeratin.

Results

Occult metastases in SLNs and non-SLNs were detected in 25 (23%) and 10 (16%) patients, respectively. The presence of occult SLN metastasis was marginally correlated with T-factor (P = 0.06), and predictive factors for occult non-SLN metastases were tumor nuclear grade (P = 0.039). With a median follow-up of 86 months, disease-free survival (P = 0.3) or overall survival (P = 0.8) did not differ between the patients with and without occult SLN metastases, regardless of backup axillary lymph node dissection.

Conclusions

SLN or non-SLN occult metastases detected by serial step sections at 85-μm intervals did not have significant prognostic implications.

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Acknowledgment

We thank to Dr. Daisaku Morita and Ms. Yukiko Ohtsuka, National Defense Medical College, and Dr. Ken Shimizu and Ms. Motoko Korematsu, Saitama Social Insurance Hospital for technical help. The study was supported in part by grants from the Foundation for Promotion of Defense Medicine and from the grant for Cancer Research from the Ministry of Health, Labor, and Welfare, Japan.

Disclosures

The authors have no conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Department of Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan

    Takashi Takeshita MD, Tomoyuki Moriya MD, Tamio Yamasaki MD, Hideki Asakawa MD, Shigeto Ueda MD, Kazuhiko Sato MD, Kazuo Hase MD & Junji Yamamoto MD

  2. Department of Basic Pathology, National Defense Medical College, Tokorozawa, Saitama, Japan

    Hitoshi Tsuda MD & Osamu Matsubara MD

  3. Department of Clinical Laboratories, National Defense Medical College, Tokorozawa, Saitama, Japan

    Shinsuke Aida MD & Seiichi Tamai MD

  4. Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan

    Hitoshi Tsuda MD

  5. Department of Pathology, International University of Health and Welfare Mita Hospital, Tokyo, Japan

    Shinsuke Aida MD

  6. Medical Service School, National Defense Force, Tokyo, Japan

    Shigeto Ueda MD

  7. Breast Oncology Center, Tokyo-West Tokushukai Hospital, Third Affiliated Hospital at Sun Yat-sen University, Tokyo, Japan

    Kazuhiko Sato MD

Authors
  1. Takashi Takeshita MD
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  2. Hitoshi Tsuda MD
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  3. Tomoyuki Moriya MD
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  4. Tamio Yamasaki MD
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  5. Hideki Asakawa MD
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  6. Shigeto Ueda MD
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  7. Kazuhiko Sato MD
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  8. Shinsuke Aida MD
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  9. Seiichi Tamai MD
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  10. Osamu Matsubara MD
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  11. Kazuo Hase MD
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  12. Junji Yamamoto MD
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Corresponding author

Correspondence to Hitoshi Tsuda MD.

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Takeshita, T., Tsuda, H., Moriya, T. et al. Clinical Implications of Occult Metastases and Isolated Tumor Cells in Sentinel and Non-Sentinel Lymph Nodes in Early Breast Cancer Patients: Serial Step Section Analysis with Long-Term Follow-Up. Ann Surg Oncol 19, 1160–1166 (2012). https://doi.org/10.1245/s10434-011-2085-5

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  • DOI: https://doi.org/10.1245/s10434-011-2085-5

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