Axillary Micro- and Macrometastases in Breast Cancer

Abstract

Recurrence and survival data at 10 years were examined for 147 women with single axillary lymph node metastases found in a modified radical or standard radical mastectomy. The cases were identified through a review of all patients with primary operable breast cancer treated at Memorial Hospital from 1964 to 1970. The patients were stratified into groups according to size of the primary tumor and of the metastatic deposit (micro less than or equal to 2 mm; macro greater than 2 mm) as well as level of the positive node. In the entire series, there was a significantly poorer prognosis among those patients with single macrometastases (30/77 patients; 39% recurrence rate) when compared with those having micrometastases (17/70 patients: 24% recurrence rate). A major prognostic difference emerged after stratification by tumor size. Within the first six years of the follow-up period, T1 patients with negative nodes and those with single micrometastases had similar survival curves, significantly better than those with macrometastases. However, at 12 years, the survival rats of those patients with either a micro- or macrometastases was nearly identical, and significantly worse than for those patients with negative lymph nodes. On the other hand, among women with primary tumors 2.1-5.0 cm (T2), patients with negative lymph nodes or single micrometastases had survival curves that did not differ significantly throughout the course of the follow-up period. Both had an outcome significantly better than observed for patients with macrometastases. These findings have important implications for our understanding of the clinical behaviour of breast cancer and for the stratification of patients entered into randomized treatment trials.

Occult axillary lymph node metastases are of no prognostic significance breast cancer

“…Some studies have classified nodal metastases according to size, using the term micrometastases for small deposits, but the cut-off has ranged between 0.2 and 2 mm. Although there is evidence that larger axillary nodal metastases are associated with a worse prognosis (Huvos et al, 1971;Fisher et al, 1978;Rosen et al, 1981;Nasser et al, 1993;McGuckin et al, 1996;Cote et al, 1999), this is not so in all studies (Wilkinson et al, 1982;Hainsworth et al, 1993) including the present one. Only two studies, however, included multivariate analysis.…”

Distinct Hypermethylation Profile of Primary Breast Cancer Is Associated with Sentinel Lymph Node Metastasis

“…It has been suggested that the amount of regional lymph node involvement is associated with a worse patient prognosis (24,25). To determine whether hypermethylation profiling of the primary tumor was associated with lymph node tumor burden, patients were categorized according to the size of the SLN metastasis as accepted by the American Joint Committee on Cancer Staging Manual sixth edition (26): macro, >2.0 mm (n = -41); micro, V2.0 mm but >0.2 mm (n = 40); and none (n = 70), absence of tumor identification following H&E and immunohistochemistry staining.…”

The clinical significance of sentinel lymph node micrometastasis in breast cancer

“…A case controlled study of 96 patients with 15 year follow-up has found that occult MM in ALNs appears to predict subsequent distant metastases in patients with stage 1 BC [32]. There are several other studies which have found a significantly poorer prognosis associated with MM [33,34]. In a prospective study of women with stage 1 BC, the International Ludwig Breast Cancer Study Group reported a 5-year disease free survival of 58% in patients with MM compared with 74% in those without and overall survival rates of 79% and 88%, respectively [35].…”