for those w micrometastasis on sentinel lymph node biopsy

[Lani]

consensus has been that "WE don't know what the clinical significance of this is"

Now, using data from the SEER analysis, an attempt has been made to quantify the increased risk present due to the presence of micrometastasis in the sentinel lymph node biopsy

Again, this does not appear to be a her2 specific study ...until I find such a thing, here it is:
1: Ann Surg Oncol. 2007 Sep 26; [Epub ahead of print]
The Prognostic Significance of Micrometastases in Breast Cancer: A SEER Population-Based Analysis.

Chen SL, Hoehne FM, Giuliano AE.
Joyce Eisenberg Keefer Breast Center, John Wayne Cancer Institute, Saint John’s Health Center, 2200 Santa Monica Blvd, Santa Monica, CA, 90404, USA, giulianoa@jwci.org.
INTRODUCTION: The prognostic significance of lymph node micrometastases in breast cancer is controversial. We hypothesized that the survival of patients with solely micrometastatic disease (N1mi) would be intermediate to patients with 1-3 tumor-positive lymph nodes (N1) and those with no positive lymph nodes (N0). METHODS: We queried the surveillance, epidemiology and end results (SEER) database for all patients between 1992 and 2003 with invasive ductal or lobular breast cancer without distant metastases and </=3 axillary nodes with macroscopic disease. Patients were stratified by nodal involvement and compared using the Kaplan-Meier method. Cox proportional hazards regression was utilized to compare survival after adjusting for patient and tumor characteristics. RESULTS: Between 1992 and 2003, N1mi diagnoses increased from 2.3% to 7% among the 209,720 study patients (p < 0.001). In a T-stage stratified univariate analysis, N1mi patients had a worse prognosis in T2 lesions. On multivariate analysis, N1mi remained a significant prognostic indicator across all patients (p < 0.0001) with a hazard ratio of 1.35 compared to N0 disease and 0.82 compared to N1 disease. Other negative prognostic factors included male gender, estrogen-receptor negativity, progesterone-receptor negativity, lobular histology, higher grade, older age, higher T-stage, and diagnosis in an earlier time period. CONCLUSION: Nodal micrometastasis of breast cancer carries a prognosis intermediate to N0 and N1 disease, even after adjusting for tumor- and patient-related factors. Prospective study is warranted and the results of pending trials are highly anticipated. Until then adjuvant therapy trials should consider using N1mi as a stratification factor when determining nodal status.
PMID: 17899293 [PubMed - as supplied by publisher]

[Mary Jo]

Huh?

Mary Jo

[Lani]

some breast cancer patients' sentinel nodes are positive only with a very tiny amount of malignant cells, which are only seen on microscopic examination

In previous years, studies classified these patients as lymph node negative.

This study looked at the fate of these women, and adjusting for other factors
(but not specifically her2 positivity), they found they fared worse than those with negative lymph nodes but better than those with a sentinel lymph node where the amount of malignant cells could easily be seen without a microscope.

There are also "nanometastases"--collections of a few cells seen with certain dyes and under the microscope. This article does not address those.

THe patients seemed to have 35% HIGHER RISK THAN THOSE WHO WERE LYMPH NODE NEGATIVE AND 28% better prognosis than those with more extensive malignant cells in their positive sentinel node.

[Mary Jo]

Thank you very much for the clear explanation Lani. I had 1 microscopic cell to my first sent. node. Second node clean. So this post did interest me. I was also considered, lymph node positive because of this finding.

Originally, at surgery, we were told they found no cancer in either of my 2 sent. nodes but upon further inspection in pathology the one microscopic cell was found.

Thanks again Lani. You are one smart cookie. :-)

Mary Jo

[Becky]

I was very much like Mary Jo but had 2 micromets to the sentinel node. Sometimes I think this might have happened due to the fine needle biopsy I had. Especially when the surgeon said that "it" was coming out regardless of the results of the biopsy (cuz it looked so nasty on film) so.... why bother with the biopsy?

If I have to go through it again I at least know so much more now and will ask, "Does it have to come out regardless because it looks nasty?" If so, no biopsy - we will find out in the operating room!

[Mary Jo]

Yes Becky, that is what my surgeon said also about the micromet to my node ~ that she felt very possibly it could have come from the sentinal node mapping that took place. Oh well - whatever, it was their and because of that fact and me not letting them go back in for more nodes to be checked I did 28 days of radiation as well. I'm kind of glad I did that too now. Added protection I guess.

Hugs,

Mary Jo

[MCS]

I also had a very small positive in sentinel node and for once, after your article, find that I was blessed, because otherwise you don't get treatment, it goes un treated.

thanks

mcs maria

[MaryAnn-CA]

Although I was diagnosed in November 2007 as node positive because of one sentinel node having one micromet, my surgeon and two oncologists told me that they did not feel an axillary node dissection was needed in my case. I questioned this because AND was the recommended standard practice for node positive patients and I wanted to err on the side of being too cautious. But when all three recommendations came back the same, I decide to pass on the axill node dissection. When it came time for radiation, my radiation oncologist, who is a nationally recognized breast cancer specialist, said she felt I did not need radiation to the axillary nodes based on having one micromet. So, although I had 35 days of radiation, the axillary node area was not included in the radiation field. My adjuvant therapy consisted of a lumpectomy and the TCH regimen. I am feeling bit nervous after seeing this study. Mary Jo ... was your 28 days of radiation to the axillary lymph nodes as well as to the site of your tumor?
Does this study indicate that I am at 35% higher risk of metastasis than node negative patients? Thanks for your support!

[Mary Jo]

Yes Mary Ann...I did receive radiation to the axilla area as well as the tumor area.

Try to relax though and remember this is just a statistic...statistics are just that....statistics..... and we are people. You are 2 years out and doing well. Hang onto that and move forward.

Sending love and hugs today...

Mary Jo

[Lien]

Besides, Mary-Anne, you did chemo, which is geared at mopping up any stray cancer cells. 2 years out after Her2 disease is very good!

Jacqueline

[MaryAnn-CA]

Mary Jo and Jacqueline, thanks so much for your kind replies. Yes, Mary Jo, statistics are just that ... not individual cases and I am very encouraged by the fact that I am NED at this point and doing well. Take care, ladies and God bless! Mary Ann