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

Pugliese, Matthew; Stempel, Michelle; Patil, Sujata; Hsu, Meier; Ho, Alice; Traina, Tiffany; Morrow, Monica; Cody, Hiram; Gemignani, Mary L.

doi:10.1016/j.amjsurg.2009.10.016

« Previous Next »The American Journal of Surgery
Volume 200, Issue 3 , Pages 368-373, September 2010

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

Matthew Pugliese, M.D.
- Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
Michelle Stempel, M.P.H.
- Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
Sujata Patil, Ph.D.
- Department of Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
Meier Hsu, B.A.
- Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
Alice Ho, M.D.
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
Tiffany Traina, M.D.
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
Monica Morrow, M.D.
- Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
Hiram Cody III, M.D.
- Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
Mary L. Gemignani, M.D.
- Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
- Corresponding author. Tel.: +1-646-888-5225; fax: +1-212-717-3214

Received 19 August 2009; received in revised form 6 October 2009

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.

Keywords: Breast cancer, Sentinel lymph node biopsy, Sentinel lymph node, Isolated tumor cells, Micrometastasis, Nanometastasis, Immunohistochemical-only sentinel lymph node, Immunohistochemical N0(I+)