Originally published as JCO Early Release 10.1200/JCO.2005.04.7076 on April 10 2006

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Axillary Sentinel Lymph Nodes Can Be Falsely Positive Due to Iatrogenic Displacement and Transport of Benign Epithelial Cells in Patients With Breast Carcinoma

Ira J. Bleiweiss, Chandandeep S. Nagi, Shabnam Jaffer

From the Lillian and Henry Stratton/Hans Popper Department of Pathology, Mount Sinai School of Medicine, New York, NY

Address reprint requests to: Ira J. Bleiweiss, MD, Department of Pathology, Mount Sinai School of Medicine, Box 1194, 1 Gustave L. Levy Pl, New York, NY 10029; e-mail: i.bleiweiss{at}mountsinai.org

PURPOSE: Immunohistochemical (IHC) staining for cytokeratins (CK) is common practice in evaluating sentinel lymph nodes (SLNs) in patients with breast carcinoma. IHC positivity typically indicates metastasis. SLN procedures are increasingly common in patients with pure intraductal carcinoma (DCIS). Iatrogenic epithelial cell displacement and benign transport of breast epithelial cells into axillary lymph nodes are recently described phenomena. We report 25 cases in which these factors probably resulted in benign epithelial cells in axillary SLNs (ie, false positivity).

METHODS: We reviewed 25 cases of CK-positive SLNs in which the epithelial cells had histologic and IHC characteristics different from their respective patients’ underlying breast carcinomas.

RESULTS: In all cases, the cytologic features of the epithelial cells in the SLNs were benign, and 22 matched those of corresponding intraductal papillomas that were involved by or were separate from the DCIS in the original cores or surgical biopsies. Fifteen cases were pure DCIS; most invasive tumors were smaller than 1.0 cm. In six carcinomas (DCIS) showing strong Her-2/neu staining, the corresponding epithelial cells in the SLNs were negative. In 13 tumors that were strongly and uniformly positive for estrogen receptor (ER), the cytokeratin-positive cells in the SLNs were negative for ER. Nineteen cases showed benign epithelial cell displacement at the biopsy site.

CONCLUSION: Epithelial cells in SLNs may result from transport of displaced cells, usually originating in intraductal papillomas. Positive immunohistochemical results in SLNs should be interpreted with extreme caution to avoid automatically concluding that such cells represent metastasis. Sentinel lymph nodes in breast carcinoma can be falsely positive.

Presented in part at the 27th Annual San Antonio Breast Cancer Symposium, December 2004, and at the United States/Canadian Academy of Pathologists Annual Meeting, Vancouver, BC, March 2004. The study was approved by the institutional review board of the authors’ institution.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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