Influence of Isolated Tumor Cells in Sentinel Nodes on Outcome in Small, Node-Negative (pT1N0M0) Breast Cancer

Abstract

The findings suggest that presence of isolated tumor cells in the sentinel nodes is an adverse prognostic factor in early breast cancer, but its prognostic significance in association with standard factors may be limited.

Prognostic impact of isolated tumor cells in breast cancer axillary nodes: single tumor cell(s) versus tumor cell cluster(s) and microanatomic location

“…In one of these, however, overall survival was lower in patients who had not undergone an additional axillary lymph node dissection as compared with patients who had undergone an axillary lymph node dissection (P = 0.02) [17]. On the other hand, in three studies, including the two by far largest studies, the presence of isolated tumor cells did have a negative impact on breast cancer outcome [2,20,25]. In one study (n = 63), the 5-year breast cancer-specific survival (95.7% vs. 98.4%, P = 0.035) was decreased and the 5-year rate of distant metastasis (8.1% vs. 1.9%, P = 0.001) was increased for patients with pN0(i?)…”

“…as compared with pN0 patients, even though adjuvant systemic therapy was significantly more often administered to patients with pN0(i?) as final status [20]. The MIRROR study not only included a large group of patients (n = 2,707) but also analyzed patients without adjuvant systemic therapy [2].…”

Lymph node ratio, number of excised nodes and sentinel-node concepts in breast cancer

“…In the preliminary report from the EORTC 10981-22023 AMAROS Trial the further nodal involvement in patients with macrometastasis, micrometastasis and ITCs in SNs was 41%, 18% and 18% respectively [11], according to the results of other studies underlined in the review by Pepels and colleagues. Maaskant-Braat and colleagues in their report on this Journal found no statistically significant difference in survival between patients with micrometastasis or ITCs in SNs compared to those patients with tumor-free SNs [12]. However in the study by de Boer and coll.…”

“…Previously, we have shown in the Dutch MIRROR study that isolated tumor cells and micrometastases as final nodal status are significantly associated with increased risk of disease-events at a hazard ratio of about 1.5 as compared with patients having node-negative disease [10]. Some other SN studies could [11,12] but some could not confirm this association between micrometastatic disease and clinical outcome [13][14][15]. However, it is noted that the MIRROR study is by far the largest SN study on prognostic relevance of isolated tumor cells and micrometatases, with outcome being assessed in patients who had not received systemic therapy and SN classification on full central pathology revision, and by such offering the most robust data on this issue.…”

Sentinel lymph node metastasis after neoadjuvant treatment in breast cancer: Any size matters?

“…The prognostic implications of minimal lymph node involvement (i.e., isolated tumor cells, micrometastasis) in early breast cancer have been long debated. The impact of finding this minimal metastasis in the SLN in the adjuvant setting has been reported extensively with different outcomes due to the great variability in patient population, tumor characteristics, histology assessment and so on [22,23] . Even more, the significance of micrometastasis in patients with ALND seems to be worst than in patients with SLN, making more difficult to establish its real significance [24] .…”