The role of cytokeratin immunohistochemical slain of axillary sentinel lymph nodes as a predictor of axillary lymph node dissection findings

L. Chinsoo Cho, Ann Spangkr, Phuc Nguyen, A. Marilyn Leitch, David Euhus, Hossein Saboorian

Research output: Contribution to journalArticlepeer-review

Abstract

The significance of positive cytokeratin immunohistochemical(lHC) staining in sentinel axillary lymph nodes in breast cancer remains unclear. Authors reviewed a database of 904 consecutive patients participating in a sentinel lymph node(SLN) biopsy study at UTSW. There were 58 out of 904 patients (6.4%) who lacked evidence of SLN metastasis by hematoxylin-eosin stain but were found to have IHC positive cells in the SLN. Forty-seven of the 58 patients subsequently underwent axillary lymph node dissection (ALND). The characteristics of these 47 patients included a median age of 55 (37-76) and a median primary tumor size of 2.0 (0.4-7.2) cm. The location of the primary tumor included 25(53%) upper outer quadrant, 7(15%) upper inner quadrant, (11%) lower inner quadrant, 3(6%) lower outer quadrant, and 7(15%) between quadrants. Thirty-four (72%) of the patients had positive estrogen receptors (ER). Her-2-neu positive tumors were found in 12 (26%) of the patients. The median number of lymph nodes removed was 3 (1-7) for SLN biopsy and 17 (4-31) for ALND. There were two (4%) patients who had additional positive nodes found at ALND. One of the patients with a primary tumor size of 2.3 cm invasive ductal histology(IDC), ER ( + ), and Her-2-neu (-) had 1 mm metastasis in a SLN, but had 13 of 16 lymph nodes with metastasis on ALND. The other patient with a primär)- tumor size of 3.9 cm IDC, ER (-), and Her-2-neu (-) had three SLNs each with 1 mm metastasis and 2 of 9 lymph nodes with metastasis on ALND each containing 0.4 cm metastasis. In conclusion, the patients with only 1HC slain evidence of SLN metastasis have a low likelihood of additional metastasis at ALND. However, those patients who did have additional métastases had significant disease burden that would likely manifest as a clinical problem without ALND. Additional studies are required to better define parameters that predict for additional positive nodes at ALND.

Original languageEnglish (US)
Number of pages1
JournalCancer Journal
Volume9
Issue number6
DOIs
StatePublished - Jan 1 1996

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