Cancer Axillary Lymph Node Research Articles

PP-4-34 Axillary lymph nodes in breast cancer: Assessment with ‘power’ doppler ultrasound

PP-4-34 Axillary lymph nodes in breast cancer: Assessment with ‘power’ doppler ultrasound

Hormone-Regulated Genes (pS2, PIP, FAS) in Breast Cancer and Nontumoral Mammary Tissue

Expression of the hormone-regulated genes, pS2, prolactin-inducible protein (PIP) and fatty acid synthetase (FAS), was investigated by Northern blotting in primary breast carcinoma, metastatic breast cancer in axillary lymph nodes, in uninvolved breast tissue from mastectomies and in normal lymph nodes. There were considerable differences in expression of the genes between the tissues. The proportion of tissues containing PIP-mRNA decreased from uninvolved breast tissue to primary breast carcinoma to metastatic carcinoma. The reverse applied to FAS-mRNA which was found more often in metastatic cancer than in primary cancer, and least frequently in uninvolved breast tissue. Yet another pattern was observed for pS2 expression. The highest proportion of tissues demonstrating gene expression was found in primary breast cancer with both metastatic tumor and uninvolved breast tissue expressing the gene less frequently. pS2-mRNA and PIP-mRNA could only rarely be detected in trace amounts in normal lymph nodes. In contrast, FAS-mRNA was present in about one third of normal lymph nodes. Only pS2-mRNA showed an association with estrogen and progesterone receptor status.

Intra-patient variation between breast cancer axillary lymph node metastases using quantifiable features.

The intra-patient variations of some clinically relevant quantifiable features, between axillary lymph node metastases were evaluated in 44 breast cancer patients. In all lymph node metastases detected (range 2-33 per patient), the mitotic figures were counted, the volume percentage epithelium was assessed and the mean nuclear area was measured. The intra-patient variation for each quantifiable feature was expressed by the coefficient of variation (CV). Since the measurement techniques used introduce a certain, well known variation themselves because of sampling and measurement errors, the CVs found had to be greater than methodological tolerance limits (established in previous studies) to be interpreted as indicating biological variation. The CVs exceeded the methodological tolerance limits in 86% of the cases for the mitotic count, in 48% of the cases for the volume percentage epithelium, and in 47% of the cases for the mean nuclear area. This indicated that in these cases, the variation found in the quantifiable features could not be explained by sampling or measurement errors and should be regarded as real biological variation. Furthermore, the variation in the quantifiable features studied showed a significant positive correlation with the number of lymph node metastases. Thus, there may be considerable intra-patient variation in quantifiable features between axillary lymph node metastases in breast cancer. This may indicate that these lymph node metastases originate independently from different clones within the primary tumour, that they are independently formed in different stages of tumour development, or that they, as an expression of intrinsic tumour heterogeneity, may develop in different directions from the start.

Prognostic significance of breast cancer axillary lymph node micrometastases assessed by two special techniques: reevaluation with longer follow-up.

Special techniques such as serial macroscopic sectioning (SMS) or immunohistochemical staining (IH) improve the detection rate of micrometastases but this detection is of value only if it improves the prediction of recurrence and survival. We first studied the prognosis of 120 patients with a single micrometastasis detected by SMS in a series of 1,680 primary operable breast carcinoma with a median follow-up of 7 years. A significant difference in recurrence (P = 0.005) and in survival (P = 0.0369) was found between node-negative patients and those with one single SMS micrometastasis, but SMS micrometastases were not a predicting factor by multivariate analyses according to the Cox model. We then studied the prognostic significance of patients with a micrometastasis detected by IH in node-negative carcinoma: 37 micrometastases from a series of 89 invasive lobular carcinoma (ILC) and 13 single micrometastases from a series of 129 invasive ductal carcinoma (IDC). In the ILC group, IH micrometastases had no prognostic value (median follow-up: 9.3 years). In the IDC group, IH micrometastases were correlated with recurrences (P = 0.01) and were the most significant predicting factor, but were less correlated with survival (median follow-up: 15.6 years). Three main points emerge from this study: (1) SMS micrometastases have a prognostic significance and macroscopic sectioning is recommended as a routine technique not requiring excessive work. (2) IH micrometastases in infiltrating lobular carcinoma have no prognostic significance. (3) The value of IH is debatable in infiltrating ductal carcinoma, since the technique is of principal use in predicting recurrences. It should therefore be carefully assessed vs other prognostic factors currently under study.

Are breast cancer axillary node micrometastases worth detecting?

Are breast cancer axillary node micrometastases worth detecting?

Are breast cancer axillary node micrometastases worth detecting?

Are breast cancer axillary node micrometastases worth detecting?

The Reliability of Histologically Negative Axillary Lymph Nodes in Breast Cancer: Preliminary Report

In an effort to evaluate the reliability of negative axillary lymph nodes in breast cancer patients, we did recuts in three levels in order to detect occult metastases. Our material consisted of 50 breast cancer cases with negative axilla. From each lymph node two routine sections were reviewed. Consequently, we examined six additional sections from the recuts. Out of the 50 cases, 7 (14%) had occult metastases in one or more section. Our results suggest that a negative axilla in the routine study can show in a considerable percentage occult metastases corresponding to the number of recuts. This means that a sufficient number of patients have only theoretically negative axillary lymph nodes and for that reason may show a low survival rate and a worse prognosis than the one expected. On the other hand, the need for axillary dissection or the appropriate postoperative treatment for carcinoma of the breast is supported.

Palpable axillary lymph nodes in cancer of the breast. Structural and biologic considerations.

The presence of bilaterally palpable axillary lymph nodes was previously found to be a prognostically favorable clinical sign. This study has sought to determine whether patients having bilaterally palpable lymph nodes are characterized by distinctive features in their homolateral nodes and primary tumors. The authors collected groups of cases according to the presence or absence of metastases to axillary lymph nodes and the palpability of their homolateral and heterolateral nodes. The superior survival of patients with bilaterally palpable lymph nodes was most closely correlated with superior sinus histiocytosis reactivity of the homolateral lymph nodes. The findings are discussed in relation to the concept of tumor-host interactions and the therapeutic implications.