Five year follow-up of patients with operable breast cancer whose sentinel nodes were completely sectioned at 0.25mm.

Abstract

Abstract Abstract #1017 Background: 20-30% of patients with operable breast cancer and negative axillary lymph nodes develop recurrence within 10 years. With the advent of sentinel lymph node biopsy (SLNB) as a substitute to axillary lymph node dissection for staging of these patients, detailed examination of sentinel nodes for metastases has become feasible. Our group has previously reported on detection of 25% occult metastases in 200 patients with T1-T2 invasive breast cancer whose sentinel nodes were initially sectioned at 2-3 mm intervals and stained with H&E. The blocks were then sectioned at 0.25 mm intervals in the entirety and stained with immuno-histochemical technique (IHC). Some patients were given conventional chemo-hormonal therapy based upon tumor prognostic factors. We now present the disease recurrence in these patients at median follow-up of five years.
 Methods: Prospectively registered records of 209 consecutive patients with T1-T2 invasive breast cancer treated with lumpectomy and sentinel node biopsy at Rush University Medical Center by three surgeons between December 1997 and May 2002 were reviewed. Of the remaining 175, the nodes were sectioned at 0.25 mm throughout and stained with IHC. The remaining 123 cases had no metastases. Adjuvant chemo-hormonal therapy was given to 38 patients with unfavorable prognostic factors and none to 85.
 Results: The mean age of the patients and their tumor size were 54.6 years and 1.44 cm respectively. The mean length of follow up was 5.8 years. 34 of 209 patients had metastases in their sentinel nodes based on 2-3 mm sectioning and H&E staining. They were offered adjuvant chemo-hormonal therapy. 27 accepted and7 did not. Of the 209 patients, 175 had negative SLNB by routine examination. Of these, 52 (29.7%) were found to have occult metastases (isolated cells: 31, colonies> 0.2 mm: 21) upon 0.25 mm sectioning and IHC staining. Details of the findings are summarized in the table. The incidence of disease recurrence was noted to be similar in the subsets of patients with and without occult metastases.
 Conclusion
 Complete sectioning of the sentinel nodes in 209 patients with T1 and T2 breast cancer resulted in detection of occult metastases in 52 patients ranging in size from single cells to colonies of cells measuring up to 1500 microns. However, the incidence of disease recurrence at 5 year appears unaffected by these metastases.
 
 m*: Small metastases: isolated cells
 M*: Large metastases: colonies of cells. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1017.