importance of micromets in the node less than .02 cm.....
 

Axillary lymph node nanometastases are prognostic factors for metastatic relapse in breast cancer patients

S. Alberti, P. Querzoli, M. Pedriali, R. Rinaldi, E. Biganzoli, P. Boracchi, M. Piantelli, S. Iacobelli, E. Marubini and I. Nenci University of Chieti, Chieti Scalo, Italy; University of Ferrara, Ferrara, Italy; National Cancer Institute, Milano, Italy; University of Milano, Milano, Italy

610

Background: Early breast cancer presents with a remarkable and largely unaccounted for heterogeneity of outcomes. Undetected, microscopic lymph node tumor deposits may account for a significant fraction of this prognostic diversity. Thus, we systematically evaluated the presence of lymph node tumor cell deposits <0.2 mm in diameter [pN0(i+), nanometastases], and analysed their prognostic impact. Methods: Seven hundred and two single institution, consecutive patients with 8 years of median follow-up were studied. To maximize the chances of detecting micro and nanometastases, whole-axilla dissections were analysed. pN0 cases were systematically reevaluated by step sectioning and anti-cytokeratin immunohistochemical analysis of 6676 corresponding dissected lymph nodes. The risk of first adverse events and of distant relapse of bona fide pN0 patients was compared with that of pN0(i+), pN1mi and pN1 cases. Crude cumulative incidence (CCI) curves were used to estimate the cumulative probability of occurrence of adverse events. CCI curves were compared by the Gray’s test. A proportional sub distribution hazard (SDH) regression model was utilized to assess the difference among CCI curves of pN0(i+) versus pN0(i-), and of pN1mi versus pN0(i+). Competing risks were accounted for and regression models were adjusted for established breast cancer prognostic factors, i.e. grading, pathological T stage and age. Proportional SDH assumptions were checked using Schoenfeld-type residuals. Results: A pN0(i+) status was shown to be a strong risk factor for event-free survival (P<0.0005) and for metastatic relapse in both univariate and multivariate analyses accounting for competing risks and adjusted for grading, pathological T stage and age. Conclusions: Our findings demonstrate that nanometastases are an important risk factor in breast cancer. These results support the inclusion of procedures for nanometastasis detection in TNM pathological staging.

No significant financial relationships to disclose.

I noticed that this is one of the abstracts that will be presented at the 2006 San Antonio bc conference. Oh yes, the topics at to be discussed on are the website now!

Forgive me if this is a dumb question, but are micro and nano metastases the same thing, or is one smaller than the other?

Hopeful

I don't know, you know, nano has to be very small. I mean less than .2mm is nano, I think, and .02cm to 2cm is micro, I think. Anyway, the implications of the article, is even the tiniest thing is a bad thing when its in the node. Ug, oh no.

RobinP, something I have wondered for quite a while is how accurate some of the nodal classifications are that go back before "breadloafing" and IHC staining of the nodes became common (which I guess is when Sentinel Node biopsies became standard care). Makes me think that there were more than a few "node positives" lumped in with the "node negative" stats. Maybe true node negatives have a better recurrence rate? Who knows, just call me . . . . .


Hopeful

Well, Hope amazing what technology brings, sometimes things maybe you rather not know, but then again better that you do know for best treatment. I'm one of those that was positive node by IHC only, not H&E. Anyway, about 30% of node negative by traditional standards of H&E were found to relaspe, probably most of them would be node positive by newer IHC testing.

Hopeful, I like that name. Just keep posting, we need a lot of that around here you know..."Hopeful". Take care...

I stained 2 micromets to my sentinel node (both were less than 1.8 mm). At my surgery, my surgeon said I was lucky to be node negative but at Sloane - they said "whoa Nellie" and discovered 2 tiny mets to the sentinel. So... depressingly, I ended up with one node involved. Thankfully so however because I got AC followed by Taxol and had no problem getting Herceptin too. I think if I didn't have the node involved (or it was but not discovered), I would have had 4 AC (since the tumor was over 1cm) but that would have been it. So I think in the long run, it worked out since 2 spots is not as bad as a loaded node and it really had to be looked for.


So, I always say that besides a second medical opinion, one should always get the slides looked at by another pathologist as well.

Have a nice weekend

Becky

Becky, how are ya, probably on the chat now, ah? Well, anyway I agree on multiple medical opinions, perhaps more than two. Here's why. A certain major NY City cancer center, that I am not suppose to disclose due to a legal payoff to me for their mistake, misdiagnosed me on my second pathology opinion.

I had a lumpectomy locally where only DCIS was found. Then the major cancer center did a second opinion and agreed it was only DCIS. Then I had a mastecomty with sentinel due to large size of DCIS. That's when the micro met node was found and they didn't know what to make of it for prognosis, particulary since I had only DCIS. Then they said do CMF for six month, just to be safe. Anyway, after I was done CMF, I had the lumpectomy slides checked since I finally noticed that my pathologist at the major cancer center was not "breast pathologist but anotomical". So I had their " breast pathologist" check the slides for a third time and that's when the freaking invasive 4mm her2+ bc was found. And the orginal pathologist at the major cancer center was required to admend his records. In other words, he agreed he made an error. Scary story, isn't it from a major cancer center?

Robin

Hopefully, with newer diagnostics available there will be fewer misdiagnosis made. In my case I don't have to worry about the nano or micro mets in the lymph nodes. There was definitely no doubt about my lymph nodes.

Wow, Kate a lot of +nodes! God bless you girl. I just hope that the treatments kick this thing in the butt for you and you never have to deal with bc again. Take care...