Relationship Between Histologic Features of Primary Breast Carcinomas and Axillary Lymph Node Micrometastases: Detection and Prognostic Significance

Abstract

The incidence and prognostic significance of micrometastases (Mic-Met) in axillary lymph nodes (LNs) is still controversial. We compared Mic-Met detection of invasive mammary carcinomas (IMCs) in axillary LNs using second review of hematoxylin and eosin (H&E)-stained slides and immunohistochemistry (IHC) relating them with features of the primary tumor, and determining their influence on overall survival (OS) and disease-free survival (DFS). We studied 188 cases of IMCs with no axillary metastases in the initial reports. The original H&E slides of LN were re-viewed and new sections were submitted for IHC using pancytokeratin (AE1/AE3). All primary breast tumors were re-viewed and classified according to Page et al (1998) and College of American Pathologists criteria (2000). Tumors were graded using the Nottingham grading system. Kaplan-Meier curves were used to evaluate OS and DFS of 147 patients. Mic-Met detection was correlated to histologic features of primary tumor (size, type, grade, lymphatic/blood vessel invasion). Mic-Met were detected in 26/188 cases (by IHC: 23/188, 12.2%; by H&E: 12/188, 6.4%). The re-view of H&E slides showed good specificity (98.2%), but low sensitivity (39.1%), when compared with IHC. There was no relationship between features of primary tumor and Mic-Met detection, including patients with lobular carcinomas or IMCs with lobular features. There was no statistical difference in OS and DFS of patients with and without Mic-Met, but patients with Mic-Met presented lower survival curves. In conclusion, there was no relationship between histologic features of primary tumor and presence of Mic-Met, nor between Mic-Met detection and patients survival.

Immunohistochemical detection of axillary lymph node micrometastases in breast cancer patients: Increasing the accuracy of detection and decreasing labor intensive serial sectioning

“…[13] McGuckin et al found lymph node metastases detection rate of 35% in cases with tumor size >2 cm as compared with 20% in cases with tumor size ≤2 cm and obtained a statistically significant correlation between tumor size and lymph node metastases detected by IHC. [3] In a study by Cote et al, 26% of the cases with tumor size >2 cm were positive for lymph node metastases detected by IHC as compared with 16% of the cases with tumor size ≤2 cm positive for lymph node metastases Wells et al [7] 1984 CK, EMA 15 Trojani et al [8] 1987 CK, EMA, HMFG1,HMGF2, AUA1 14 Berry et al [9] 1988 HMFG1, HMFG2, E29,CAM 5.2 17.3 Sedmak et al [10] 1989 CK AE1/AE3 14.4 Raymond and Leong [6] 1989 CK 23 Springall et al [11] 1990 CAM 5.2, HMFG2 20 Mascarel et al [4] 1992 CK, EMA,HMFG1, HMGF2, AUA1 22.9 Hainsworth et al [12] 1993 BC2, BC3, 3E1.2 12 Nasser et al [13] 1993 CK AE1/AE3, CAM 5.2 14 Cote et al [2] 1999 CK AE1, CAM 5.2 20 Umekita et al [14] 2002 CK AE1/AE3 14.2 de Mascarel et al [15] 2002 CK, EMA, HMFG1, HMFG2, AUAI 10 (IDC) and 41 (ILC) Lara et al [16] 2003 CK AE1/AE3, CAM 5.2 13 El-Tamer et al [17] 2005 CK (AE1/AE3 and KL1) 6 Broekhuizen et al [18] 2006 CAM 5.2 11 Marinho et al [19] 2006 CK AE1/AE3 12.2…”

Clinical Implications of Immunohistochemically Demonstrated Lymph Node Micrometastasis in Resectable Pancreatic Cancer

“…Some defined micrometastasis as metastatic tumor cells not detectable on routine histologic examination, whereas others (24-27) considered metastatic tumor cells by size into "micrometastases" (measuring > 0.2 mm) and "isolated tumor cells" (measuring ≤ 0.2 mm), as recommended by the sixth edition of the TNM classification of malignant tumors by UICC (16). Our definition of micrometastasis was the presence of tumor cells in regional lymph nodes not detected on routine H&E staining and we divided the metastasis into single-cell and cluster types in light of previous suggestions that this differentiation may be important (24-27).…”

Contribuição da imuno-histoquímica na avaliação de fatores prognósticos e preditivos do câncer de mama e no diagnóstico de lesões mamárias

“…Em 13/137 casos (9,5%), identificou-se a presença de células epiteliais metastáticas, tanto micrometástases (com dimensão entre 0,2 a 2 mm) como células tumorais isoladas (dimensão < 0,2 mm). A literatura relata taxas de detecção de micrometástases em 7% a 42% em linfonodos axilares, dependendo do método de estudo empregado (25)(26)(27)45) . Sabe-se que aproximadamente 25% dos pacientes linfonodo-negativos desenvolverão recidiva da doença e que poderiam talvez ter se beneficiado de quimioterapia adjuvante.…”