Micrometastases in bone marrow in patients with primary breast cancer: evaluation as an early predictor of bone metastases.

Abstract

The bone marrow of 307 patients with primary breast cancer was examined for tumour cells by immunocytochemistry using an antiserum to epithelial membrane antigen. Micrometastases were found in 81 cases (26.4%) and their presence was related to various poor prognostic factors: spread to lymph nodes, vascular invasion, T stage, and pathological size. The median duration of follow up was 28 months. Seventy five patients relapsed, 60 at distant sites. Of these 60 patients, 26 had micrometastases detected at presentation and 34 were free of micrometastases initially. The relapse free interval was significantly shorter for patients with micrometastases, and these patients had a shorter survival. Analysis of the sites of relapse showed that the test

Prognostic relevance of urokinase plasminogen activator detection in micrometastatic cells in the bone marrow of patients with primary breast cancer

“…TCD in bone marrow correlates with prognosis in patients with primary breast cancer. Other authors obtained similar results (Mansi et al, 1987;Schlimok et al, 1987;Untch et al, 1988;Osborne et al, 1991). The bone marrow of 80% of patients with subsequent metastasis was TCD positive at the time of first diagnosis (Diel et al, 1996).…”

Tumour cell detection in the bone marrow of breast cancer patients at primary therapy: results of a 3-year median follow-up

“…The percentage of tumour cell-positive patients (38%) in this study is slightly higher than in our earlier publications (Harbeck et al, 1987;Untch et al, 1988) or the percentage reported by some other groups (Mansi et al, 1987;Schlimok et al, 1987;Porro et al, 1988;Ellis et al, 1989;Diel et al, 1990). One explanation might be an improved detection rate by using an antibody cocktail instead of a single monoclonal antibody.…”

“…Thus, they were able to rule out possible tumour cell spread due to surgical manipulation. Yet another argument against a merely artificial spread of tumour cells by surgical intervention is the fairly constant percentage of tumour cell detection in the literature, whether bone marrow aspirates are taken immediately before (Mansi et al, 1987;Porro et al, 1988;Cote et al, 1991) or after (Harbeck et al, 1987;Diel et al, 1992) primary surgery. In our opinion, multiple aspiration sites as well as the use of cocktails of monoclonal antibodies are likely to play a far more important role in an increased detection rate.…”

“…However, the role of vascular invasion (Mansi et al, 1987) was not evaluated. In our study, keeping in mind that the numbers in some subgroups are still small, tumour cell presence appears to be an independent prognostic factor.…”

Randomised trial of chemotherapy versus endocrine therapy in patients presenting with locally advanced breast cancer (a pilot study)

“…Future trials will establish the impact of this form of primary systemic treatment on mortality from this disease. However, we feel that improved survival may result since it will be possible to select adjuvant therapy more accurately (a) selecting those that are endocrine sensitive using immunocytochemical tests, (b) by evaluating sensitivity of the primary tumour and thus response of micrometastases (McClelland et al, 1986;Coombes et al, 1986;Mansi et al, 1987).…”