HER2 Support Group Forums - View Single Post - Sentinel lymph node biopsy linked to rise in micrometastatic breast cancer

Hopeful · 07-18-2007, 09:19 AM

Grace,

I followed the link to the abstract at the bottom of the article in my link above, and discovered that the full text of the article is available for free: http://jnci.oxfordjournals.org/cgi/c...ull/99/13/1044.

An interesting quote:

"SLNB, used in preference to ALND, may be the cause of a stage migratory or "Will Rogers" effect (12,36,38). For example, if SLNB reveals micrometastatic lymph node foci, stage IIA disease (T2N0—tumors sized 2–5 cm with no disease in the lymph nodes [N0]) could become stage IIB (T2N1—tumors sized 2–5 cm with one positive, micrometastatic lymph node). Thus, before the advent of SLNB, stage II node-positive breast cancers may have been considered to be stage I, node-negative disease. Our findings may reflect the impact of such upstaging on breast cancer incidence rates."

They go on to say that the method used to identify the micro mets (i.e., E&H with IHC) did not add to the stage migratory effect. However, this is in conjunction with SLNB, where we are still talking about microscopic examination vs. gross examination of the node, so it does not, to me, discount the statement in the paragraph above.

Otherwise, they don't really offer an explanation, that I can see. They conclude, "While the use of SLNB in community practice continues to increase, it is expected that cases with lymph node metastases also will continue to increase," which, I think, is consistent with the basic premise of micro vs. macro examination of the nodes.

Hope this helps,

Hopeful

07-18-2007, 09:19 AM	#5
Hopeful Senior Member Join Date: Aug 2006 Posts: 3,380	Grace, I followed the link to the abstract at the bottom of the article in my link above, and discovered that the full text of the article is available for free: http://jnci.oxfordjournals.org/cgi/c...ull/99/13/1044. An interesting quote: "SLNB, used in preference to ALND, may be the cause of a stage<SUP> </SUP>migratory or "Will Rogers" effect (12,36,38). For example, if<SUP> </SUP>SLNB reveals micrometastatic lymph node foci, stage IIA disease<SUP> </SUP>(T2N0—tumors sized 2–5 cm with no disease in the<SUP> </SUP>lymph nodes [N0]) could become stage IIB (T2N1—tumors<SUP> </SUP>sized 2–5 cm with one positive, micrometastatic lymph<SUP> </SUP>node). Thus, before the advent of SLNB, stage II node-positive<SUP> </SUP>breast cancers may have been considered to be stage I, node-negative<SUP> </SUP>disease. Our findings may reflect the impact of such upstaging<SUP> </SUP>on breast cancer incidence rates." They go on to say that the method used to identify the micro mets (i.e., E&H with IHC) did not add to the stage migratory effect. However, this is in conjunction with SLNB, where we are still talking about microscopic examination vs. gross examination of the node, so it does not, to me, discount the statement in the paragraph above. Otherwise, they don't really offer an explanation, that I can see. They conclude, "While the use of SLNB<SUP> </SUP>in community practice continues to increase, it is expected<SUP> </SUP>that cases with lymph node metastases also will continue to<SUP> </SUP>increase," which, I think, is consistent with the basic premise of micro vs. macro examination of the nodes. Hope this helps, Hopeful