Does the Method of Biopsy Affect the Incidence of Sentinel Lymph Node Metastases?
Identifieur interne : 006C25 ( Istex/Corpus ); précédent : 006C24; suivant : 006C26Does the Method of Biopsy Affect the Incidence of Sentinel Lymph Node Metastases?
Auteurs : Erika L. Newman ; Amina Kahn ; Kathleen M. Diehl ; Vincent M. Cimmino ; Celina A. Kleer ; Alfred E. Chang ; Lisa A. Newman ; Michael S. SabelSource :
- The Breast Journal [ 1075-122X ] ; 2006-01.
Abstract
Abstract: More detailed examination of the sentinel lymph node (SLN) in breast cancer has raised concerns about the clinical significance of micrometastases, specifically isolated tumor cells detected only through immunohistochemical (IHC) staining. It has been suggested that these cells do not carry the same biologic implications as true metastatic foci and may represent artifact. A retrospective institutional review board‐approved review was conducted on clinically node‐negative breast cancer patients who underwent SLN biopsy (SLNB) between 1997 and 2003. Retrospective analysis of tumor characteristics and the method of the initial diagnostic biopsy were correlated with the presence and nature of metastatic disease in the SLN. Of 537 SLNBs, 123 (23%) were hematoxylin‐eosin (H&E) positive. SLN positivity strongly correlated with tumor size (p < 0.001) and tumor grade (p = 0.025), but not with the method of biopsy (needle versus excisional biopsy). Prior to July 2002, we routinely evaluated H&E‐negative SLNs with IHC (n = 381). Of the 291 H&E‐negative patients, 26 had IHC‐only detected micrometastases (9%). The likelihood of detecting IHC‐only metastases did not correlate with tumor size or grade, but was significantly higher in patients undergoing excisional biopsy than core needle biopsy. While the method of biopsy has no demonstrable effect on the likelihood of finding metastases in the SLN by routine serial sectioning and H&E staining, it may significantly impact the likelihood of finding micrometastases by IHC. IHC should not be used routinely in the evaluation of the SLN and caution should be used when basing treatment decisions (completion axillary lymph node dissection or adjuvant therapy) on IHC‐only detected micrometastases.
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DOI: 10.1111/j.1075-122X.2006.00179.x
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Newman</name><affiliation><mods:affiliation>Departments of Surgery and</mods:affiliation></affiliation></author><author><name sortKey="Kahn, Amina" sort="Kahn, Amina" uniqKey="Kahn A" first="Amina" last="Kahn">Amina Kahn</name><affiliation><mods:affiliation>Departments of Surgery and</mods:affiliation></affiliation></author><author><name sortKey="Diehl, Kathleen M" sort="Diehl, Kathleen M" uniqKey="Diehl K" first="Kathleen M." last="Diehl">Kathleen M. Diehl</name><affiliation><mods:affiliation>Departments of Surgery and</mods:affiliation></affiliation></author><author><name sortKey="Cimmino, Vincent M" sort="Cimmino, Vincent M" uniqKey="Cimmino V" first="Vincent M." last="Cimmino">Vincent M. Cimmino</name><affiliation><mods:affiliation>Departments of Surgery and</mods:affiliation></affiliation></author><author><name sortKey="Kleer, Celina A" sort="Kleer, Celina A" uniqKey="Kleer C" first="Celina A." last="Kleer">Celina A. 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Sabel</name><affiliation><mods:affiliation>Departments of Surgery and</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: msabel@umich.edu</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j" type="main">The Breast Journal</title><title level="j" type="alt">BREAST JOURNAL</title><idno type="ISSN">1075-122X</idno><idno type="eISSN">1524-4741</idno><imprint><biblScope unit="vol">12</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="53">53</biblScope><biblScope unit="page" to="57">57</biblScope><biblScope unit="page-count">5</biblScope><publisher>Blackwell Publishing Inc</publisher><pubPlace>Malden, USA</pubPlace><date type="published" when="2006-01">2006-01</date></imprint><idno type="ISSN">1075-122X</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1075-122X</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract">Abstract: More detailed examination of the sentinel lymph node (SLN) in breast cancer has raised concerns about the clinical significance of micrometastases, specifically isolated tumor cells detected only through immunohistochemical (IHC) staining. It has been suggested that these cells do not carry the same biologic implications as true metastatic foci and may represent artifact. A retrospective institutional review board‐approved review was conducted on clinically node‐negative breast cancer patients who underwent SLN biopsy (SLNB) between 1997 and 2003. Retrospective analysis of tumor characteristics and the method of the initial diagnostic biopsy were correlated with the presence and nature of metastatic disease in the SLN. Of 537 SLNBs, 123 (23%) were hematoxylin‐eosin (H&E) positive. SLN positivity strongly correlated with tumor size (p < 0.001) and tumor grade (p = 0.025), but not with the method of biopsy (needle versus excisional biopsy). Prior to July 2002, we routinely evaluated H&E‐negative SLNs with IHC (n = 381). Of the 291 H&E‐negative patients, 26 had IHC‐only detected micrometastases (9%). The likelihood of detecting IHC‐only metastases did not correlate with tumor size or grade, but was significantly higher in patients undergoing excisional biopsy than core needle biopsy. While the method of biopsy has no demonstrable effect on the likelihood of finding metastases in the SLN by routine serial sectioning and H&E staining, it may significantly impact the likelihood of finding micrometastases by IHC. IHC should not be used routinely in the evaluation of the SLN and caution should be used when basing treatment decisions (completion axillary lymph node dissection or adjuvant therapy) on IHC‐only detected micrometastases.</div></front></TEI><istex><corpusName>wiley</corpusName><keywords><teeft><json:string>node</json:string><json:string>metastasis</json:string><json:string>micrometastases</json:string><json:string>axillary</json:string><json:string>biopsy</json:string><json:string>excisional</json:string><json:string>breast cancer</json:string><json:string>excisional biopsy</json:string><json:string>surg</json:string><json:string>prognostic</json:string><json:string>alnd</json:string><json:string>sentinel</json:string><json:string>lymph</json:string><json:string>sentinel node</json:string><json:string>slnb</json:string><json:string>pathol</json:string><json:string>occult</json:string><json:string>tumor cells</json:string><json:string>completion alnd</json:string><json:string>core needle biopsy</json:string><json:string>sentinel nodes</json:string><json:string>sentinel lymph node biopsy</json:string><json:string>prognostic significance</json:string><json:string>tumor size</json:string><json:string>carcinoma</json:string><json:string>breast cancer patients</json:string><json:string>breast carcinoma</json:string><json:string>serial sectioning</json:string><json:string>excisional biopsies</json:string><json:string>clinical significance</json:string><json:string>sentinel lymph nodes</json:string><json:string>retrospective</json:string><json:string>needle biopsy</json:string><json:string>lymphatic mapping</json:string><json:string>additional disease</json:string><json:string>positive slns</json:string><json:string>lymph nodes</json:string><json:string>completion axillary lymph node dissection</json:string><json:string>lymph node metastases</json:string><json:string>sentinel lymph node</json:string><json:string>cytokeratin staining</json:string><json:string>occult axillary lymph node metastases</json:string></teeft></keywords><author><json:item><name>Erika L. Newman MD</name><affiliations><json:string>Departments of Surgery and</json:string></affiliations></json:item><json:item><name>Amina Kahn MD</name><affiliations><json:string>Departments of Surgery and</json:string></affiliations></json:item><json:item><name>Kathleen M. Diehl MD</name><affiliations><json:string>Departments of Surgery and</json:string></affiliations></json:item><json:item><name>Vincent M. Cimmino MD</name><affiliations><json:string>Departments of Surgery and</json:string></affiliations></json:item><json:item><name>Celina A. Kleer MD</name><affiliations><json:string>Pathology, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan</json:string></affiliations></json:item><json:item><name>Alfred E. Chang MD</name><affiliations><json:string>Departments of Surgery and</json:string></affiliations></json:item><json:item><name>Lisa A. Newman MD</name><affiliations><json:string>Departments of Surgery and</json:string></affiliations></json:item><json:item><name>Michael S. Sabel MD</name><affiliations><json:string>Departments of Surgery and</json:string><json:string>E-mail: msabel@umich.edu</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>breast cancer</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>immunohistochemistry</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>micrometastases</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>needle biopsy</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>sentinel lymph node</value></json:item></subject><articleId><json:string>TBJ179</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>article</json:string></originalGenre><abstract>Abstract: More detailed examination of the sentinel lymph node (SLN) in breast cancer has raised concerns about the clinical significance of micrometastases, specifically isolated tumor cells detected only through immunohistochemical (IHC) staining. It has been suggested that these cells do not carry the same biologic implications as true metastatic foci and may represent artifact. A retrospective institutional review board‐approved review was conducted on clinically node‐negative breast cancer patients who underwent SLN biopsy (SLNB) between 1997 and 2003. Retrospective analysis of tumor characteristics and the method of the initial diagnostic biopsy were correlated with the presence and nature of metastatic disease in the SLN. Of 537 SLNBs, 123 (23%) were hematoxylin‐eosin (H&E) positive. SLN positivity strongly correlated with tumor size (p > 0.001) and tumor grade (p = 0.025), but not with the method of biopsy (needle versus excisional biopsy). Prior to July 2002, we routinely evaluated H&E‐negative SLNs with IHC (n = 381). Of the 291 H&E‐negative patients, 26 had IHC‐only detected micrometastases (9%). The likelihood of detecting IHC‐only metastases did not correlate with tumor size or grade, but was significantly higher in patients undergoing excisional biopsy than core needle biopsy. While the method of biopsy has no demonstrable effect on the likelihood of finding metastases in the SLN by routine serial sectioning and H&E staining, it may significantly impact the likelihood of finding micrometastases by IHC. IHC should not be used routinely in the evaluation of the SLN and caution should be used when basing treatment decisions (completion axillary lymph node dissection or adjuvant therapy) on IHC‐only detected micrometastases.</abstract><qualityIndicators><score>6.167</score><pdfVersion>1.3</pdfVersion><pdfPageSize>595 x 782 pts</pdfPageSize><refBibsNative>true</refBibsNative><abstractCharCount>1765</abstractCharCount><pdfWordCount>3167</pdfWordCount><pdfCharCount>20102</pdfCharCount><pdfPageCount>5</pdfPageCount><abstractWordCount>254</abstractWordCount></qualityIndicators><title>Does the Method of Biopsy Affect the Incidence of Sentinel Lymph Node Metastases?</title><genre><json:string>article</json:string></genre><host><title>The Breast 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Publishing Inc</publisher><pubPlace>Malden, USA</pubPlace><date type="published" when="2006-01"></date></publicationStmt><notesStmt><note type="content-type" subtype="article" source="article" scheme="https://content-type.data.istex.fr/ark:/67375/XTP-6N5SZHKN-D">article</note><note type="publication-type" subtype="journal" scheme="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</note></notesStmt><sourceDesc><biblStruct type="article"><analytic><title level="a" type="main">Does the Method of Biopsy Affect the Incidence of Sentinel Lymph Node Metastases?</title><title level="a" type="short">Method of Biopsy and SLN Metastases</title><author xml:id="author-0000"><persName><forename type="first">Erika L.</forename><surname>Newman</surname><roleName type="degree">MD</roleName></persName><affiliation>Departments of Surgery and</affiliation></author><author xml:id="author-0001"><persName><forename type="first">Amina</forename><surname>Kahn</surname><roleName type="degree">MD</roleName></persName><affiliation>Departments of Surgery and</affiliation></author><author xml:id="author-0002"><persName><forename type="first">Kathleen M.</forename><surname>Diehl</surname><roleName type="degree">MD</roleName></persName><affiliation>Departments of Surgery and</affiliation></author><author xml:id="author-0003"><persName><forename type="first">Vincent M.</forename><surname>Cimmino</surname><roleName type="degree">MD</roleName></persName><affiliation>Departments of Surgery and</affiliation></author><author xml:id="author-0004"><persName><forename type="first">Celina A.</forename><surname>Kleer</surname><roleName type="degree">MD</roleName></persName><affiliation>Pathology, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan<address><country key="US"></country></address></affiliation></author><author xml:id="author-0005"><persName><forename type="first">Alfred E.</forename><surname>Chang</surname><roleName type="degree">MD</roleName></persName><affiliation>Departments of Surgery and</affiliation></author><author xml:id="author-0006"><persName><forename type="first">Lisa A.</forename><surname>Newman</surname><roleName type="degree">MD</roleName></persName><affiliation>Departments of Surgery and</affiliation></author><author xml:id="author-0007" role="corresp"><persName><forename type="first">Michael S.</forename><surname>Sabel</surname><roleName type="degree">MD</roleName></persName><affiliation>Departments of Surgery and</affiliation><affiliation>Address correspondence and reprint requests to: Michael S. Sabel, MD, 3304 Cancer Center, 1500 East Medical Center Dr., Ann Arbor, MI 48109, USA, or e‐mail: msabel@umich.edu.</affiliation></author><idno type="istex">E694BB41CD8E69865BC524D3352DF7403E89DBE0</idno><idno type="DOI">10.1111/j.1075-122X.2006.00179.x</idno><idno type="unit">TBJ179</idno><idno type="toTypesetVersion">file:TBJ.TBJ179.pdf</idno></analytic><monogr><title level="j" type="main">The Breast Journal</title><title level="j" type="alt">BREAST JOURNAL</title><idno type="pISSN">1075-122X</idno><idno type="eISSN">1524-4741</idno><idno type="book-DOI">10.1111/(ISSN)1524-4741</idno><idno type="book-part-DOI">10.1111/tbj.2006.12.issue-1</idno><idno type="product">TBJ</idno><idno type="publisherDivision">ST</idno><imprint><biblScope unit="vol">12</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="53">53</biblScope><biblScope unit="page" to="57">57</biblScope><biblScope unit="page-count">5</biblScope><publisher>Blackwell Publishing Inc</publisher><pubPlace>Malden, USA</pubPlace><date type="published" when="2006-01"></date></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><abstract xml:lang="en" style="main"><p><hi rend="bold">Abstract: </hi> More detailed examination of the sentinel lymph node (SLN) in breast cancer has raised concerns about the clinical significance of micrometastases, specifically isolated tumor cells detected only through immunohistochemical (IHC) staining. It has been suggested that these cells do not carry the same biologic implications as true metastatic foci and may represent artifact. A retrospective institutional review board‐approved review was conducted on clinically node‐negative breast cancer patients who underwent SLN biopsy (SLNB) between 1997 and 2003. Retrospective analysis of tumor characteristics and the method of the initial diagnostic biopsy were correlated with the presence and nature of metastatic disease in the SLN. Of 537 SLNBs, 123 (23%) were hematoxylin‐eosin (H&E) positive. SLN positivity strongly correlated with tumor size (p < 0.001) and tumor grade (p = 0.025), but not with the method of biopsy (needle versus excisional biopsy). Prior to July 2002, we routinely evaluated H&E‐negative SLNs with IHC (<hi rend="italic">n</hi> = 381). Of the 291 H&E‐negative patients, 26 had IHC‐only detected micrometastases (9%). The likelihood of detecting IHC‐only metastases did not correlate with tumor size or grade, but was significantly higher in patients undergoing excisional biopsy than core needle biopsy. While the method of biopsy has no demonstrable effect on the likelihood of finding metastases in the SLN by routine serial sectioning and H&E staining, it may significantly impact the likelihood of finding micrometastases by IHC. IHC should not be used routinely in the evaluation of the SLN and caution should be used when basing treatment decisions (completion axillary lymph node dissection or adjuvant therapy) on IHC‐only detected micrometastases.</p></abstract><textClass><keywords xml:lang="en"><term xml:id="k1">breast cancer</term><term xml:id="k2">immunohistochemistry</term><term xml:id="k3">micrometastases</term><term xml:id="k4">needle biopsy</term><term xml:id="k5">sentinel lymph node </term></keywords><classCode scheme="tocHeading1">ORIGINAL ARTICLES</classCode></textClass><langUsage><language ident="EN"></language></langUsage></profileDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/E694BB41CD8E69865BC524D3352DF7403E89DBE0/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Blackwell Publishing Inc</publisherName><publisherLoc>Malden, USA</publisherLoc></publisherInfo><doi origin="wiley" registered="yes">10.1111/(ISSN)1524-4741</doi><issn type="print">1075-122X</issn><issn type="electronic">1524-4741</issn><idGroup><id type="product" value="TBJ"></id><id type="publisherDivision" value="ST"></id></idGroup><titleGroup><title type="main" sort="BREAST JOURNAL">The Breast Journal</title></titleGroup></publicationMeta><publicationMeta level="part" position="01001"><doi origin="wiley">10.1111/tbj.2006.12.issue-1</doi><numberingGroup><numbering type="journalVolume" number="12">12</numbering><numbering type="journalIssue" number="1">1</numbering></numberingGroup><coverDate startDate="2006-01">January 2006</coverDate></publicationMeta><publicationMeta level="unit" type="article" position="9" status="forIssue"><doi origin="wiley">10.1111/j.1075-122X.2006.00179.x</doi><idGroup><id type="unit" value="TBJ179"></id></idGroup><countGroup><count type="pageTotal" number="5"></count></countGroup><titleGroup><title type="tocHeading1">ORIGINAL ARTICLES</title></titleGroup><eventGroup><event type="firstOnline" date="2006-01-05"></event><event type="publishedOnlineFinalForm" date="2006-01-05"></event><event type="xmlConverted" agent="Converter:BPG_TO_WML3G version:2.3.2 mode:FullText source:FullText result:FullText" date="2010-03-04"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:3.8.8" date="2014-02-10"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.1.7 mode:FullText,remove_FC" date="2014-11-04"></event></eventGroup><numberingGroup><numbering type="pageFirst" number="53">53</numbering><numbering type="pageLast" number="57">57</numbering></numberingGroup><correspondenceTo>Address correspondence and reprint requests to: Michael S. Sabel, MD, 3304 Cancer Center, 1500 East Medical Center Dr., Ann Arbor, MI 48109, USA, or e‐mail: <email>msabel@umich.edu</email>.</correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:TBJ.TBJ179.pdf"></link></linkGroup></publicationMeta><contentMeta><countGroup><count type="figureTotal" number="2"></count><count type="tableTotal" number="2"></count><count type="formulaTotal" number="0"></count><count type="referenceTotal" number="29"></count><count type="wordTotal" number="2500"></count></countGroup><titleGroup><title type="main">Does the Method of Biopsy Affect the Incidence of Sentinel Lymph Node Metastases?</title><title type="shortAuthors"><sc>newman et al.</sc></title><title type="short"><i>Method of Biopsy and SLN Metastases</i></title></titleGroup><creators><creator creatorRole="author" xml:id="cr1" affiliationRef="#a1"><personName><givenNames>Erika L.</givenNames><familyName>Newman</familyName><degrees>MD</degrees></personName></creator><creator creatorRole="author" xml:id="cr2" affiliationRef="#a1"><personName><givenNames>Amina</givenNames><familyName>Kahn</familyName><degrees>MD</degrees></personName></creator><creator creatorRole="author" xml:id="cr3" affiliationRef="#a1"><personName><givenNames>Kathleen M.</givenNames><familyName>Diehl</familyName><degrees>MD</degrees></personName></creator><creator creatorRole="author" xml:id="cr4" affiliationRef="#a1"><personName><givenNames>Vincent M.</givenNames><familyName>Cimmino</familyName><degrees>MD</degrees></personName></creator><creator creatorRole="author" xml:id="cr5" affiliationRef="#a2"><personName><givenNames>Celina A.</givenNames><familyName>Kleer</familyName><degrees>MD</degrees></personName></creator><creator creatorRole="author" xml:id="cr6" affiliationRef="#a1"><personName><givenNames>Alfred E.</givenNames><familyName>Chang</familyName><degrees>MD</degrees></personName></creator><creator creatorRole="author" xml:id="cr7" affiliationRef="#a1"><personName><givenNames>Lisa A.</givenNames><familyName>Newman</familyName><degrees>MD</degrees></personName></creator><creator creatorRole="author" xml:id="cr8" affiliationRef="#a1" corresponding="yes"><personName><givenNames>Michael S.</givenNames><familyName>Sabel</familyName><degrees>MD</degrees></personName></creator></creators><affiliationGroup><affiliation xml:id="a1"><unparsedAffiliation>Departments of Surgery and</unparsedAffiliation></affiliation><affiliation xml:id="a2" countryCode="US"><unparsedAffiliation>Pathology, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en"><keyword xml:id="k1">breast cancer</keyword><keyword xml:id="k2">immunohistochemistry</keyword><keyword xml:id="k3">micrometastases</keyword><keyword xml:id="k4">needle biopsy</keyword><keyword xml:id="k5">sentinel lymph node </keyword></keywordGroup><abstractGroup><abstract type="main" xml:lang="en"><p><b>Abstract: </b> More detailed examination of the sentinel lymph node (SLN) in breast cancer has raised concerns about the clinical significance of micrometastases, specifically isolated tumor cells detected only through immunohistochemical (IHC) staining. It has been suggested that these cells do not carry the same biologic implications as true metastatic foci and may represent artifact. A retrospective institutional review board‐approved review was conducted on clinically node‐negative breast cancer patients who underwent SLN biopsy (SLNB) between 1997 and 2003. Retrospective analysis of tumor characteristics and the method of the initial diagnostic biopsy were correlated with the presence and nature of metastatic disease in the SLN. Of 537 SLNBs, 123 (23%) were hematoxylin‐eosin (H&E) positive. SLN positivity strongly correlated with tumor size (p < 0.001) and tumor grade (p = 0.025), but not with the method of biopsy (needle versus excisional biopsy). Prior to July 2002, we routinely evaluated H&E‐negative SLNs with IHC (<i>n</i> = 381). Of the 291 H&E‐negative patients, 26 had IHC‐only detected micrometastases (9%). The likelihood of detecting IHC‐only metastases did not correlate with tumor size or grade, but was significantly higher in patients undergoing excisional biopsy than core needle biopsy. While the method of biopsy has no demonstrable effect on the likelihood of finding metastases in the SLN by routine serial sectioning and H&E staining, it may significantly impact the likelihood of finding micrometastases by IHC. IHC should not be used routinely in the evaluation of the SLN and caution should be used when basing treatment decisions (completion axillary lymph node dissection or adjuvant therapy) on IHC‐only detected micrometastases.</p></abstract></abstractGroup></contentMeta></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Does the Method of Biopsy Affect the Incidence of Sentinel Lymph Node Metastases?</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>Method of Biopsy and SLN Metastases</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Does the Method of Biopsy Affect the Incidence of Sentinel Lymph Node Metastases?</title></titleInfo><name type="personal"><namePart type="given">Erika L.</namePart><namePart type="family">Newman</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Departments of Surgery and</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Amina</namePart><namePart type="family">Kahn</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Departments of Surgery and</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Kathleen M.</namePart><namePart type="family">Diehl</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Departments of Surgery and</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Vincent M.</namePart><namePart type="family">Cimmino</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Departments of Surgery and</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Celina A.</namePart><namePart type="family">Kleer</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Pathology, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Alfred E.</namePart><namePart type="family">Chang</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Departments of Surgery and</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Lisa A.</namePart><namePart type="family">Newman</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Departments of Surgery and</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Michael S.</namePart><namePart type="family">Sabel</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Departments of Surgery and</affiliation><affiliation>E-mail: msabel@umich.edu</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article"></genre><originInfo><publisher>Blackwell Publishing Inc</publisher><place><placeTerm type="text">Malden, USA</placeTerm></place><dateIssued encoding="w3cdtf">2006-01</dateIssued><copyrightDate encoding="w3cdtf">2006</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="figures">2</extent><extent unit="tables">2</extent><extent unit="references">29</extent><extent unit="words">2500</extent></physicalDescription><abstract>Abstract: More detailed examination of the sentinel lymph node (SLN) in breast cancer has raised concerns about the clinical significance of micrometastases, specifically isolated tumor cells detected only through immunohistochemical (IHC) staining. It has been suggested that these cells do not carry the same biologic implications as true metastatic foci and may represent artifact. A retrospective institutional review board‐approved review was conducted on clinically node‐negative breast cancer patients who underwent SLN biopsy (SLNB) between 1997 and 2003. Retrospective analysis of tumor characteristics and the method of the initial diagnostic biopsy were correlated with the presence and nature of metastatic disease in the SLN. Of 537 SLNBs, 123 (23%) were hematoxylin‐eosin (H&E) positive. SLN positivity strongly correlated with tumor size (p < 0.001) and tumor grade (p = 0.025), but not with the method of biopsy (needle versus excisional biopsy). Prior to July 2002, we routinely evaluated H&E‐negative SLNs with IHC (n = 381). Of the 291 H&E‐negative patients, 26 had IHC‐only detected micrometastases (9%). The likelihood of detecting IHC‐only metastases did not correlate with tumor size or grade, but was significantly higher in patients undergoing excisional biopsy than core needle biopsy. While the method of biopsy has no demonstrable effect on the likelihood of finding metastases in the SLN by routine serial sectioning and H&E staining, it may significantly impact the likelihood of finding micrometastases by IHC. IHC should not be used routinely in the evaluation of the SLN and caution should be used when basing treatment decisions (completion axillary lymph node dissection or adjuvant therapy) on IHC‐only detected micrometastases.</abstract><subject lang="en"><genre>keywords</genre><topic>breast cancer</topic><topic>immunohistochemistry</topic><topic>micrometastases</topic><topic>needle biopsy</topic><topic>sentinel lymph node</topic></subject><relatedItem type="host"><titleInfo><title>The Breast Journal</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">1075-122X</identifier><identifier type="eISSN">1524-4741</identifier><identifier type="DOI">10.1111/(ISSN)1524-4741</identifier><identifier type="PublisherID">TBJ</identifier><part><date>2006</date><detail type="volume"><caption>vol.</caption><number>12</number></detail><detail type="issue"><caption>no.</caption><number>1</number></detail><extent unit="pages"><start>53</start><end>57</end><total>5</total></extent></part></relatedItem><identifier type="istex">E694BB41CD8E69865BC524D3352DF7403E89DBE0</identifier><identifier type="DOI">10.1111/j.1075-122X.2006.00179.x</identifier><identifier type="ArticleID">TBJ179</identifier><recordInfo><recordContentSource>WILEY</recordContentSource><recordOrigin>Blackwell Publishing Inc</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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