Complete Submission Research Articles

Elected Power in the Petrograd Garrison in 1917–1918

The article is devoted to the question of power in the Petrograd garrison throughout the Russian revolution 1917. The strict military hierarchy, discipline, and complete submission of the rank-and-file to the officer was destroyed after the February insurrection. To smooth out the contradictions within the military units, elective self-government bodies—regimental committees—were created. In all military units of Petrograd, those officers who were cruelly brutalized by soldiers were replaced by more loyal ones. The new authorities, however, very quickly ceased to meet the interests of the soldiers. Lower ranks tried to achieve direct democracy and so held all-regiment meetings, on which important issues were solved together. In a number of cases it was the all-regiment meetings that enjoyed the greater confidence of the soldiers than the ones from the more educated regimental committees. In fact, the committees began to depend on the opinion of the meetings. An attempt to regain control over the Petrograd garrison resulted in the introduction of the Institution of the Commissar of the Military Revolutionary Committee. The Commissars were initially appointed by the Soviet and were to carry out its policies. However, very soon they also became dependent on the opinions of the soldiers. The Commissar position became elected. The article concludes that any attempts to control direct democracy ended without success until the army was demobilized.

Clinical Safety of Renaming Encapsulated Follicular Variant of Papillary Thyroid Carcinoma: Is NIFTP Truly Benign?

Renaming encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC) to noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was recently suggested to prevent the overtreatment, cost and stigma associated with this low-risk entity. The purpose of this study is to document the incidence and further assess the clinical outcomes of reclassifying EFVPTC to NIFTP. We searched synoptic pathologic reports from a high-volume academic endocrine surgery hospital from 2004 to 2013. The standard of surgical pathology practice was based on complete submission of malignant thyroid nodules along with the nontumorous thyroid parenchyma. Rigid morphological criteria were used for the diagnosis of noninvasive EFVPTC, currently known as NIFTP. A retrospective chart review was conducted looking for evidence of malignant behavior. One hundred and two patients met the strict inclusion criteria of NIFTP. The incidence of NIFTP in our cohort was 2.1% of papillary thyroid cancer cases during the studied time period. Mean follow-up was 5.7years (range 0-11). Five patients were identified with nodal metastasis and one patient with distant metastasis. Overall, six patients showed evidence of malignant behavior representing 6% of patients with NIFTP. Our study demonstrates that the incidence of NIFTP is significantly lower than previously thought. Furthermore, evidence of malignant behavior was seen in a significant number of NIFTP patients. Although the authors fully support the de-escalation of aggressive treatment for low-risk thyroid cancers, NIFTP behaves as a low-risk thyroid cancer rather than a benign entity and ongoing surveillance is warranted.

Linguistic Manipulation of Political Myth in Margaret Atwood’s The Handmaid’s Tale

This paper investigates the linguistic manipulation of political myth in Margaret Atwood’s The Handmaid’s Tale. More specifically, the paper discusses the myth of the good of the nation which is linguistically manipulated verbally and nonverbally throughout the novel. Atwood’s novel is one of the distinguished dystopian narratives in the twentieth century. This type of fiction has always been a reflection of the irrationalities committed against people by those in power. This paper exposes the strategies of linguistic manipulation used by those in power to propagate for the good of the nation myth, which in turn strengthens their position, justifies their actions, and guarantees their continuation in power. In doing so, the paper uses Political Discourse Analysis to be the approach of analyzing the selected data. Lexical choices, didactic indoctrination, religionization and dehumanization are among the strategies used in the analysis of data. The main objective of this paper is to elaborate the extent to which the good of the nation myth is used by some regimes to oppress and dominate the public into complete submission to their goals. It is also an attempt to provide the public with some sort of linguistic enlightenment so as to be aware of the use and abuse of language in shaping and/or misshaping the public’s attitudes. The conclusion drawn from this paper shows that politicians rhetorically manipulate myths to normalize their practices and legitimize their irrationalities.

Synergetic role of integrating the departments of cancer registry and clinical research at an academic comprehensive cancer center.

Integration of the cancer registry and clinical research departments can have a significant impact on the accreditation process of a Commission on Cancer (CoC) Program. Here in we demonstrate that the integration of both departments will benefit as there is increased knowledge, manpower and crossover in job responsibilities in our CoC-accredited Academic Comprehensive Cancer Center. In our model this integration has led to a more successful cooperative interaction among departments, which has in turn created an enhanced combined effect on overall output and productivity. More manpower for the cancer registry has led to increased caseloads, decreased time from date of first contact to abstraction, quality of data submissions, and timely follow-up of all patients from our reference date for accurate survival analysis along with completeness of data. In 2016, our Annual Facility report showed an additional 163 cases over prediction by the state of Maryland Cancer Registry and a 39% increase in case completeness. As proof of the synergetic effectiveness of our model within one year of its implementation, the cancer center was able to apply for, and was awarded membership from Alliance for Clinical Trials in Oncology, Central IRB, and in turn led to increased clinical trial accrual from 2.8% in 2014 compared to 13.2% currently. Our cancer registry in year one submitted over 150 more cases than predicted, improved quality outcome measures displayed by our Cancer Program Practice Profile reports and had more timely and complete data submissions to national and state registries. This synergetic integration has led to a better understanding, utilization and analysis of data by an integrated team with Clinical Research expertise.

La instrucción de enfermeras como labor ideológica de la Sección Femenina (1939-1953)

La movilizacion de las mujeres por parte de Falange durante la guerra civil y la posguerra adopto unos caracteres y estructura organizativa similares a los movimientos fascistas europeos de entreguerras. El hambre, el racionamiento, las deficiencias sanitarias e higienicas, la escasez de alimentos, entre otros, motivaron que gran parte de los ciudadanos tuvieran que luchar por la supervivencia diaria. Sobre la marcha hubo que improvisar enfermeras con varios miles de muchachas, en general muy jovenes, que a golpe de cursos acelerados de enfermeria adquirian el titulo con voluntad de servicio a la patria actuando siempre bajo el total acatamiento, obediencia y sumision. En este trabajo se estudiara el papel que el franquismo atribuyo a la enfermera para asegurar la viabilidad de aquella sociedad en la lucha contra la enfermedad. Para llevar a cabo esta investigacion se ha consultado: la Hemeroteca de la Diputacion Provincial de Almeria (Yugo), la Hemeroteca Municipal de Sevilla (F.E. y El Correo de Andalucia) y la Hemeroteca digital (La Vanguardia Espanola).

Complete Tissue Submission to Increase Lymph Node Detection in Pelvic Lymph Node Packets Submitted for Patients Undergoing Radical Prostatectomy and Radical Cystectomy.

Pelvic lymphadenectomy has prognostic and therapeutic implications in both bladder and prostate cancer. Pelvic lymphadenectomy specimens are fatty and identification of lymph nodes (LNs) can be difficult during the grossing process. We investigated the benefit of a new grossing method requiring entire LN packet submission. We introduced a new grossing protocol requiring total submission of LN packets for patients undergoing radical prostatectomy (RP) or radical cystectomy (RC). A retrospective review was performed to evaluate clinical and pathologic data for RP (n = 59) and RC (n = 56) cases performed 18 months prior to and 18 months following implementation of the new lymphadenectomy grossing protocol. For RP and RC cases, significantly more LNs were found when total LN packets were submitted with the new technique: mean 14.1 versus 8.7, and mean 25.2 versus 15.9, respectively ( P = .007, P = .011). For RP cases, there was no significant change in the number of LN packets submitted for evaluation from the operating room ( P = .76). For RC cases, more LNs were found with the new technique despite a significantly fewer number of LN packets sent from the operating room in the cohort that were processed with the new technique: mean 2.2 versus 4.0 LN packets ( P < .001). Significantly more paraffin blocks were required using the new grossing method for both RP and RC: mean 13.53 versus 6.9 and mean 19.0 versus 12.4, respectively ( P < .001, P = .018). Submitting all additional fatty tissue after palpable identification of LNs can significantly increase the detection of LNs in RP and RC cases.

Complete vs Partial Submission of Radical Prostatectomy Specimens: A Departmental Cost Analysis Study with Clinical Correlation

Complete vs Partial Submission of Radical Prostatectomy Specimens: A Departmental Cost Analysis Study with Clinical Correlation

Blackening of Files for Hypo Committee of Inquiry illegal

Since the beginning of 2015, the newly inserted Art 138b para 1 subpara 4 B-VG stipulates that the Constitutional Court pronounces on divergences of opinion between a National Council’s committee of inquiry, 25% of its Members and legal entities concerning the obligation of the latter to provide information to the committee of inquiry. In the present judgment with regard to the Hypo committee of inquiry, the Court had to apply this new provision for the first time. In response to the committee’s request to submit files and documents in accordance with the object of investigation, the Federal Minister of Finance blackened text passages to a significant extent. He argued that a complete submission would not comply with the statutory confidentiality and secrecy provisions. Since the committee issued a so-called ‘decision of persistence’, the Finance Minister filed an application to the Court to settle this divergence of opinion promptly. The Court concluded that all legal entities required to provide information must submit the requested files and documents (covered by the object of investigation) without blackening regardless of statutory secrecy provisions. At the same time, the Constitutional Court made it clear that this obligation does not confer the committee unrestricted competence to publish the pieces of information obtained in such a way but itself has to weigh up the competing private and public interests.

PRM46 - Why Peer-Review Journals Reject Real-World And Health-Economic Papers

To evaluate the most common reasons provided by peer-reviewed journals to reject manuscripts describing data derived from real-world or health-economic (RW/HE) studies. Our company project administration records from the last 10 years were reviewed for manuscripts describing HE studies, RW/observational studies (including retrospective database analyses), and patient or disease registries. Reasons for rejection were collected and stratified into “categories”. If more than one reason was provided by the journal, then all reasons were counted. Our analysis was based on industry-sponsored manuscripts for which a complete submission history was available. Rejection letters were collected for 78 manuscripts. Of these, 12 did not specify a reason for rejection. The remaining records revealed a total of 100 rejection counts. The most common reasons were ‘priority rating not high enough’ (33%), ‘concerns about the methodology’ (18%), and ‘information not sufficiently novel’ (15%). Other reasons for rejection included ‘topic not appropriate for the journal’ (7%), ‘manuscript is biased/conclusions are too strong’ (5%), ‘industry involvement not sufficiently disclosed’ (2%), and referral to a sister journal instead (2%). These common reasons for rejection could provide authors with some guidance on which factors are particularly important to focus on during the development of a RW/HE manuscript to help improve the chances of acceptance by peer-reviewed journals.

Total submission of lymphadenectomy tissues removed during radical prostatectomy for prostate cancer: possible clinical significance of large-format histology.

Complete submission of lymphadenectomy specimens increases the number of recovered lymph nodes and the detection of metastatic disease. There are advantages with the whole-mount technique over complete sampling with standard cassettes in terms of time needed to sample the tissue, number of blocks to be cut, and slides to be examined. The clinical significance of the approach is that all lymph nodes are identified, including those that are not palpable. In particular, this approach avoids the fact that an individual lymph node is oversampled and counted according to number of pieces obtained by the pathologist, mainly in nodes with considerable size.

Persuasive Ironies:

Persuasive Ironies:

Total submission of pelvic lymphadenectomy tissues removed during radical prostatectomy for prostate cancer increases lymph node yield and detection of micrometastases

The detection of lymph node metastases has prognostic and therapeutic implications for patients undergoing radical prostatectomy for prostate cancer. Macroscopic identification of pelvic lymph nodes in surgical lymphadenectomy specimens can be difficult, with a potential for incomplete submission of lymph nodes for microscopic examination. This study was undertaken to determine whether complete sampling of lymphadenectomy specimens would improve the detection of metastatic disease in patients undergoing radical prostatectomy. We examined 109 pelvic lymphadenectomies accompanying radical prostatectomy specimens to assess the benefit of complete submission of the lymph node packets to detect extra lymph nodes and metastatic disease. We found that blocking the residual tissue, after all palpable lymph nodes had been identified, increased the mean number of lymph nodes from 3.8 to 10.8, with an average of 0.84 macroscopically undetectable nodes being recovered per block submitted. Metastatic prostate cancer was identified in eight cases, one of which had cancer in an impalpable lymph node only. Submission of all pelvic lymphadenectomy tissue for histological examination improves the yield of lymph nodes and the detection of metastatic prostate cancer.

Sample submissions to a diagnostic laboratory

The quality and appropriateness of samples submitted to a veterinary diagnostic laboratory have a significant effect on the quality of the test results obtained. A veterinary technician can be of valuable assistance with veterinary diagnostic sample submission. Specimens that are properly collected and preserved are beneficial in helping to establish a diagnosis. Prior to collecting samples, it is important to know what type of sample is needed for the suspected diagnostic differentials, size or quantity of sample needed, type of storage container, shipping requirements, and any special handling recommendations. The technician may assist the veterinarian in collecting specimens, consult with animal owners on sample collection, contact the diagnostic laboratory if needed, complete submission forms, and pack and ship samples.

1630 PROSTATE PATHOLOGY IN PARTIAL VERSUS COMPLETE SUBMISSIONS OF CYSTOPROSTATECTOMY SPECIMENS

You have accessJournal of UrologyBladder Cancer: Invasive (II)1 Apr 20131630 PROSTATE PATHOLOGY IN PARTIAL VERSUS COMPLETE SUBMISSIONS OF CYSTOPROSTATECTOMY SPECIMENS Zhan Tao (Peter) Wang, Emily Filter, Manal Gabril, Jose Gomez, Johnathan Izawa, Joseph Chin, and Madeleine Moussa Zhan Tao (Peter) WangZhan Tao (Peter) Wang London, Canada More articles by this author , Emily FilterEmily Filter London, Canada More articles by this author , Manal GabrilManal Gabril London, Canada More articles by this author , Jose GomezJose Gomez London, Canada More articles by this author , Johnathan IzawaJohnathan Izawa London, Canada More articles by this author , Joseph ChinJoseph Chin London, Canada More articles by this author , and Madeleine MoussaMadeleine Moussa London, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3180AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The incidence of clinically significant prostate cancer (PCa) in cystoprostatectomy (CP) specimens is 25%. There are no guidelines for the pathological examination of prostates in CP specimens. In our institution, prior to 2000, the prostates were partially submitted whereas currently all prostates are completely submitted. The aim of this study is to evaluate the incidence, pathological features and clinical outcomes of patients with PCa found on CP specimens with partial versus complete submission. METHODS CP specimens with incidental PCa were identified from our archives between 1990 to 2006. Patients with known metastatic PCa, previous radiotherapy or partial prostatectomy were excluded. A total of 72 patients were found, 51 (complete group) had CP specimens that underwent complete submission versus 21 (partial group) that were partially submitted. Clinical outcomes were retrospectively collected via paper and electronic charts. Each CP specimen was retrieved and reviewed by the pathology department. Clinically significant PCa was defined as: Gleason score > 7, seminal vesical invasion, extraprostatic extension (EPE) and positive surgical margins. Statistical analysis was performed with the Student t-test, Fisher's exact test and the Kaplan-Meier method. Significance was set at <0.05. RESULTS Patient demographics between the two groups were similar. Median follow-up for the partial and complete group were 65.7 and 72.9 months respectively. There was a total of 40 (55.5%) clinically significant PCa, of these 13 were in the partial group versus 27 in the complete group. Positive surgical margins at the apex was found in 7% of specimens and EPE was found in 2 versus 11 specimens in the partial and complete group respectively. Invasive urothelial carcinoma was found in 7 specimens in the partial group versus 11 in the complete group. There was one death from metastatic PCa in the complete group and none in the partial group. There was no significant difference in overall mortality between the two groups (Figure 1). CONCLUSIONS This study comparing partial versus complete submission of the prostates in CP specimens showed no significant differences in the detection of clinically significant PCa or survival. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e670 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zhan Tao (Peter) Wang London, Canada More articles by this author Emily Filter London, Canada More articles by this author Manal Gabril London, Canada More articles by this author Jose Gomez London, Canada More articles by this author Johnathan Izawa London, Canada More articles by this author Joseph Chin London, Canada More articles by this author Madeleine Moussa London, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Will the EU Clinical Trials Regulation Support the Innovative Industry in Bringing New Medicines Faster to Patients?

A perspective from the innovative industry is provided in this article about the long awaited legal proposal for a Clinical Trial Regulation (“Proposal”), adopted in July 2012. With this Proposal, the European Commission reacted to a call by all stakeholders for more harmonization and streamlining of the provisions for conducting clinical trials in the EU. Discrepant approaches between Member States, a failure to respect legal timelines, and a lack of formal coordination mechanisms within and between Member States have resulted in an increased workload for the industry and contributed to a decline in Europe’s attractiveness as a place to carry out research and development. The Proposal introduces a concept whereby the sponsor makes a single submission of the clinical trial application dossier to an EU portal, which is followed by a single assessment based on cooperation between Member States. A possibility for the sponsor to choose a ‘reporting Member State’ to take the lead on key aspects of the assessment is expected to support excellence building and work sharing of Competent Authorities in the EU. The Proposal respects the fact that certain aspects need to be reviewed nationally. The new process aims to lead to a single decision per clinical trial per concerned Member State. The rules are built on the principle of strict adherence to timelines for authorization. The timelines are ambitious but at the same time competitive, as the process builds in mechanisms that strengthen compliance. The rules have been designed to encourage sponsors to file complete submission packages, since any substantial modification to a trial would lead to delays in its commencement. Sponsors need to streamline their internal processes accordingly. In the end, streamlining is an effort that needs to be accepted by all parties involved. The Proposal does not detail how Member States organize the involvement of different bodies, such as Competent Authorities and Ethics Committees, because according to the EU Treaty, the EU cannot legislate on aspects falling into pure Member State competence. The Proposal, however, establishes the assessment objectives on the basis of Good Clinical Practices set by the International Conference on Harmonisation (ICH) and the Declaration of Helsinki by the World Medical Association. As such, the new legislation is likely to have implications on Member States’ internal organization. In addition, Ethics Committees in Europe would benefit from an EU platform for best practice exchange—a concept that would need to be requested by the Council and the European Parliament through the legislative process. A single decision system for the entire EU per clinical trial has been discussed as an option, but such an approach was difficult to achieve while respecting national competencies. In this situation, the Proposal represents an acceptable compromise, provided its proposed mechanisms, processes, and timelines are retained upon implementation. As the Proposal is now on the table for discussion by the 27 Member States’ governments and by the European Parliament, co-legislators and stakeholders should be aware that any dilution of these provisions would be detrimental to the objective to ensure patient access and make the conditions for clinical research in Europe attractive and fit for the future.

Spectrum of squamous epithelial-lined cysts of the ovary (SECO): a case report of a mature teratoma of ovary masquerading as an epidermoid cyst (EC)

Aims To provide a differential diagnosis/histogenesis of squa-mous epithelial-lined cysts of the ovary (SECO). Methods A case of a 42-year-old with a history of ovarian cystec-tomy for strumal carcinoid, presenting with a squamous epithelial-lined cyst in an ipsilateral oophorectomy and confirmed as residual teratoma, was reviewed. A literature search was also conducted. Results Oophorectomy showed a keratin-filled cyst lined by mature stratified squamous epithelium with no skin adnexae or other overt tissue elements and resembling epidermoid cyst (EC). The entire lesion was processed and a single, small focus of smooth muscle identified in the cyst wall. Discussion EC is included in the WHO classification under monodermal teratomas, although its histogenesis is still controver-sial. 1 Some authors have shown that many EC reflect inadequately sampled teratomas or metaplasia in Brenner tumours and endome-triosis, and suggest pure EC probably comprise 2 Other possibilities include metaplasia in surface epithelial tumours, epithelial inclusion cysts, rete ovarii or hilar mesonephric tubules, while skin implantation during previous surgery has also been suggested. 1 As teratoma and EC may have different clinical follow-up, accurate diagnosis is important. 1 Our case highlights the importance of correlation with previous pathology and complete submission of the lesion to identify less prominent teratomatous components.

E-Learning Perception and its Relationship with Demographic Variables

The last decade is witness to a number of education centers offering e-learning courses. This paper explores students’ perceptions about e-learning as a potential medium for delivering business education. The sample comprises of students studying full-time business management course at IIM-A, a premiere management institute in India. An online survey comprising of close-ended questions was administered to a set of 240 students. In response, 154 complete and usable submissions were received. An analysis was carried out on to identify the e-learning awareness and degree of familiarity of the students with the various e-learning technologies and factor analysis was carried out on statements on perception to extract the underlying factors of perceptions. Subsequently, a chi-square analysis was carried out to determine the relationship between perception and various demographic variables like gender, age group, education, educational background and work experience. Further, a one way ANOVA is performed to examine whether the mean factor scores vary across demographic variables.

Practice-Based Learning and Improvement: A Two-Year Experience with the Reporting of Morbidity and Mortality Cases by General Surgery Residents

The Accreditation Council for Graduate Medical Education (ACGME) core competency of practice-based learning and improvement can be assessed with surgical Morbidity and Mortality Conference (MMC). We aim to describe the MMC reporting patterns of general surgery residents, describe the adverse event rate for patients and compare that with existing published rates, and describe the nature of our institutional adverse events. We hypothesize that reporting patterns and incidence rates will remain constant over time. In this retrospective cohort study, archived MMC case lists were evaluated from January 1, 2009 to December 31, 2010. The reporting patterns of the residents, the adverse event ratios, and the specific categories of adverse events were described over the academic years. χ(2) and Fisher's exact tests were used to compare across academic years, using an α = 0.05. There were 85 surgical MMC case lists evaluated. Services achieved a reporting rate above 80% (p < 0.001). The most consistent reporting was done by postgraduate year (PGY) 5 level chief residents for all services (p > 0.05). Out of 11,368 patients evaluated from complete MMC submissions, 289 patients had an adverse event reported (2.5%). This was lower than published reporting rates for patient adverse event rates (p < 0.001). Adverse event rates were consistent for residents at the postgraduate year 2, 4, and 5 levels for all services (p > 0.05). Over 2 years, 522 adverse events were reported for 461 patients. A majority of adverse events were from death (24.1%), hematologic and/or vascular events (16.7%), and gastrointestinal system events (16.1%). Surgery resident MMC reporting patterns and adverse event rates are generally stable over time. This study shows which adverse event cases are important for chief residents to report.

“We will call this ‘doing our exorcises’”

Even though Audrey Thomas’s Mrs. Blood (1970) has received a considerable amount of critical attention, what has not been analysed in detail is the complex interaction between the novel’s existential themes and its highly poetic language. By relying on Julia Kristeva’s insights on the link between border crossing experiences and a discourse that is marked by the discharge of affects, this paper intends to come to a better appreciation of the novel’s strong association of narrative and style. By closely analysing several passages, it argues that even though Mrs. Thing — the rationalizing side of the narrator’s persona — feels alienated from normative, communicative discourse as it cannot accommodate her border crossing experiences, her fear of losing all grasp on self and meaning makes her desperate to hold on to the symbolic. Significantly, both her narrative as well as that of her alter ego are characterized by syntactic, lexical and phonetic disruptions (i.e. the semiotic) that give expression to affects and emotions that resist being silenced or bound into strict patterns. The novel’s discourse, in other words, undermines the narrator’s desire for stability and illustrates that both Mrs. Thing’s overreliance on normative communication (i.e. the symbolic) and Mrs. Blood’s complete submission to the discharge of affects (i.e. the semiotic) are disastrous for the speaking subject.

Occult axillary lymph node metastases do not have prognostic significance in early stage breast cancer.

Axillary lymph node status is one of the most powerful prognostic indicators in patients with breast cancer and has implications for adjuvant treatment. It has been demonstrated that enhanced histologic evaluation of axillary lymph nodes, including serial sectioning of paraffin tissue blocks and immunohistochemical (IHC) staining, increases the rate of detection of occult metastases. The clinical significance of occult lymph node metastases has been the subject of debate. In the current study, the authors identified 267 patients who underwent axillary lymph node dissection (ALND) between 1987 and 1995 and were lymph node negative according to a routine pathologic evaluation, which included the complete submission of all lymph nodes and an examination of 1 hematoxylin and eosin (H&E)-stained section per paraffin block. Patients did not receive systemic chemotherapy or hormone therapy. All of the dissected lymph nodes from these patients were re-evaluated by intensified pathologic methods (serial sectioning with H&E levels plus IHC). Occult metastases were categorized by detection method and size. The clinical significance of the occult metastases was determined. Thirty-nine patients (15%) who had lymph node-negative results on routine evaluation of their ALND specimens had occult metastases identified. Eight of these patients (20%) had macrometastases >2.0 mm, 15 (40%) had micrometastases (range, >0.2 mm to ≤2 mm), and 16 (40%) had isolated tumor cells (≤0.2 mm). The presence of occult metastases and the size of metastases did not affect recurrence-free or overall survival. The presence of occult metastasis did not have clinical significance in this cohort of patients with early stage breast cancer.