Abstract
Background
We determined the presence or absence of and clinical significance of cytokeratin-positive cells in the lymph nodes of patients who had had mastectomies for ductal carcinoma-in-situ.
Methods
Two pathologists independently assessed the axillary lymph nodes found. All patients had either a core or open biopsy performed before the time of mastectomy. The lymph nodes were assessed with hematoxylin and eosin stain and immunohistochemistry for cytokeratin marker AE1/AE3. The slides were assessed for the presence or absence of epithelial cells. As a control, axillary lymph nodes found in prophylactic mastectomies were assessed. None of these had had a previous biopsy performed.
Results
Lymph nodes from all patients demonstrated no obvious epithelial cells on hematoxylin and eosin stain. Peripheral sinuses of lymph nodes from six patients (23%) who had mastectomies for ductal carcinoma-in-situ contained a few cytokeratin-positive cells on immunohistochemistry. The lymph nodes of the control group demonstrated no cytokeratin-positive cells. The mean follow-up of patients was 5 years, and all patients were alive without recurrence at the time of the study.
Conclusions
Epithelial cells may be present in the lymph nodes draining a site of recent breast biopsy in the absence of invasive carcinoma, indicating that these are an artifact of recent surgery and not of micrometastatic disease.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Giuliano A, Haigh P, Brennan M, et al. Prospective observational study of sentinel lymphadenectomy without further axillary dissection in patients with sentinel node-negative breast cancer.J. Clin Oncol 2000:18:2553–9.
Liberman L. Pathological analysis of sentinel lymph nodes in breast carcinoma.Cancer 2000;88:971–6.
Tabar L, Fagerberg G, Duffy SW, Day NE, Gad A, Grontoft O. Update of the Swedish two-county program of mammographic screening for breast cancer.Radiol Clin North Am 1992;30:187–210.
Siewert JR, Kestlmeier R, Busch R, et al. Benefits of D2 lymph node dissection for patients with gastric cancer and pN0 pN1 lymph node metastases.Br J Surg 1996;83:1144–7
Krag D, Weaver D, Ashikaga T, et al. The sentinel node in breast cancer a multicenter validation study.N Engl J Med 1999;339:941–6
Albertni J, Lyman G, Cox C, et al. Lymphatic mapping and sentinel node biopsy in the patient with breast cancer.JAMA 1996;276:1818–22.
Giuliano A, Jones R, Brennan M, Statman R. Sentinel lymphade-nectomy in breast cancer.J Clin Oncol 1997;15:2345–50.
Veronesi U, Paganelli G, Galimberti V, et al. Sentinel node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph nodes.Lancet 1997;349:1864–7.
Weaver D, Krag D, Ashikaga T, Harlow S, O’Connell M. Pathological analysis of sentinel and nonsentinel lymph nodes in breast carcinoma.Cancer 2000;88:1099–107.
Fitzgibbons PL, Connolly JL, Page DL, et al. Prognostic factors in breast cancer. College of American Pathologists Consensus statement.Arch Pathol Lab Med 2000;124:966–78.
Turner R, Ollila D, Stern S, et al. Optimal histopathological examination of the sentinel lymph node for breast carcinoma staging.Am. J. Surg. Pathol 1999;23:263–7.
Van Diest P. Histopathological workup of sentinel lymph nodes: how much is enough?J Clin Pathol 1999;52:871–3.
Mies C, Schlesselman J. Detection of “occult” lymph node metastasis in breast cancer: should pathologists go the extra mile?Adv Anat Pathol 2000;7:149–52.
Pendas S, Dauway E, Guiliano R, et al. Sentinel node biopsy in ductal carcinoma in situ patients.Ann Surg Oncol 2000;7:15–20.
Cox C, Ku N, Nguyen K, et al. Importance of lymphatic mapping in ductal carcinoma in situ (DCIS).Am Surg 2001;67:513–9.
Silverstein M, Parker S, Grotting J, Cote R, Russell C. Ductal carcinoma in situ (DCIS) of the breast: diagnostic and therapeutic controversies.J Am Coll Surg 2001;192:196–214.
Fisher B, Dignam J, Walmark N, et al. Lumpectomy and radiation therapy for the treatment of intraduct carcinoma in situ: first results of the EORTC randomized phase III trial 10852.Lancet 2000;355:528–33.
Julien J-P, Bijker N, Feintiman I, et al. Mortility among women with ductal carcinoma in situ of the breast in the population-based surveillance, epidemiology and end results program.Arch Intern Med 2000;160:953–8.
Kelley S, Komorowski R, Dayer A. Axillary sentinel lymph node examination in breast carcinoma.Arch Pathol Lab Med 1999;123:533–5.
Nasser IA, Lee AK, Bossari S, Saganich R, Heatley G, Silverman ML. Occult axillary lymph node metastases in “node-negative” breast cancer.Hum Pathol 1993;24:950–7.
Fischer E, Palekar A, Rockette H, Redmond C, Fischer B. Pathological findings from the national surgical adjuvant breast cancer project: significance of axillary nodal micro- and macrometastases.Cancer 1978;42:2032–8.
Rosen P, Saigo P, Braun D Jr. Occult axillary lymph node metastasis from breast cancers with intramammary lymphatic tumour emboli.Am J Surg Pathol 1982;6:639–41.
International Breast Cancer Study Group. Prognostic importance of occult axillary lymph node micrometastases from breast cancers.Lancet 1999;354:896–900.
Dowlatshahi K, Fan M, Snider H, Habib F. Lymph node micrometastases from breast carcinoma. Reviewing the dilemma.Cancer 1997;80:1188–97.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tamhane, R., Dahlstrom, J.E., McCallum, D.D. et al. The clinical significance of cytokeratin-positive cells in lymph nodes at the time of mastectomy from patients with ductal carcinoma-in-situ. Annals of Surgical Oncology 9, 999–1003 (2002). https://doi.org/10.1007/BF02574519
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02574519