The clinical impact and outcomes of immunohistochemistry-only metastasis in breast cancer

• Published in: The American journal of surgery Vol. 200; no. 3; pp. 368 - 373
• Main Authors: Pugliese, Matthew, M.D, Stempel, Michelle, M.P.H, Patil, Sujata, Ph.D, Hsu, Meier, B.A, Ho, Alice, M.D, Traina, Tiffany, M.D, Morrow, Monica, M.D, Cody, Hiram, M.D, Gemignani, Mary L., M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-09-2010; Elsevier; Elsevier Limited
• Subjects: Adult; Aged; Aged, 80 and over; Axilla - pathology; Biological and medical sciences; Biopsy; Breast cancer; Breast Neoplasms - pathology; Cancer; Cancer therapies; Case-Control Studies; Chemotherapy; Chi-Square Distribution; Dissection; Endocrine therapy; ErbB-2 protein; Female; General aspects; Gynecology. Andrology. Obstetrics; Histology; Humans; Immunohistochemical N0(I+); Immunohistochemical-only sentinel lymph node; Immunohistochemistry; Immunohistochemistry - methods; Isolated tumor cells; Lymph; Lymph Node Excision; Lymph nodes; Lymphatic Metastasis - diagnosis; Lymphatic Metastasis - pathology; Lymphatic system; Lymphedema; Mammary gland diseases; Mastectomy; Medical prognosis; Medical sciences; Metastases; Metastasis; Micrometastasis; Middle Aged; Multivariate analysis; Nanometastasis; Patients; Prognosis; Proportional Hazards Models; Retrospective Studies; Risk Factors; Sentinel lymph node; Sentinel Lymph Node Biopsy; Surgery; Survival; Therapy; Tumors; Isolated tumor cells; Immunohistochemical N0(I+); Sentinel lymph node; Sentinel lymph node biopsy; Micrometastasis; Nanometastasis; Breast cancer; Immunohistochemical-only sentinel lymph node; Immunohistochemistry; Breast disease; Prognosis; Metastasis; Malignant tumor; Immunohistochemical NO(I+); Medicine; Mammary gland diseases; Anatomic pathology; Treatment; Biopsy; Surgery; Immunohistochemicalonly sentinel lymph node; Isolated cell; Evolution; Mammary gland; Tumor cell; Cancer
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2009.10.016

Abstract Background Modern surgical and pathological techniques can detect small-volume axillary metastases in breast cancer with unknown clinical significance. Methods A retrospective database review from 1996 through 2004 identified all patients with immunohistochemical (IHC)-only sentinel node (IHC-SN) metastases and compared them with negative controls (Neg-SN). Results When comparing the 232 IHC-SN patients with the 252 Neg-SN controls, the IHC-SN patients had larger tumors, more lobular histology, a higher grade, and more HER2/neu positivity. They also received more systemic therapy. With a median follow-up of 5 years, there were no differences in recurrence-free survival or overall survival. In 123 IHC-SN patients treated with axillary dissection (axillary lymph node dissection), 16% had positive non-SLNs. Patients with positive non-SLNs tended to have worse outcomes. Conclusions IHC-only sentinel lymph node (SLN) metastases were associated with worse prognostic features and higher rates of systemic therapy. However, no outcomes differences were noted.