Originally published as JCO Early Release 10.1200/JCO.2008.19.0686 on August 31 2009

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Impact of Micrometastases in the Sentinel Node of Patients With Invasive Breast Cancer

From the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA.

Corresponding author: Armando E. Giuliano, MD, John Wayne Cancer Institute, 2200 Santa Monica Blvd, Santa Monica, CA 90404; e-mail: giulianoa{at}jwci.org.

Purpose Lymph node metastases are the most significant prognostic indicator for patients with breast cancer. Sentinel node biopsy (SNB) has led to an increase in the detection of micrometastases in the sentinel node (SN). This prospective study was designed to determine the survival impact of micrometastases in SNs of patients with invasive breast cancer. This study is based on the new sixth edition of the American Joint Committee on Cancer (AJCC) staging criteria.

Patients and Methods Between January 1, 1992 and April 30, 1999, 790 patients entered this prospective study at the John Wayne Cancer Institute. The SN was examined first by hematoxylin and eosin (HE), and if the SN was negative with HE, then immunohistochemical staining was performed. The patients were then divided into four groups based on AJCC nodal staging: pN0(i–), no evidence of tumor (n = 486); pN0(i+), tumor deposit 0.2 mm (n = 84); pN1mi, tumor deposit more than 0.2 mm but 2 mm (n = 54), and pN1, tumor deposit more than 2 mm (n = 166). Disease-free survival (DFS) and overall survival (OS) were estimated using the Kaplan-Meier method. The log-rank test was used to determine differences in DFS and OS of patients from different groups.

Results At a median follow-up of 72.5 months, the size of SN metastases was a significant predictor of DFS and OS.

Conclusion Patients with micrometastatic tumor deposits, pN0(i+) or pN1mi, do not seem to have a worse 8-year DFS or OS compared with SN-negative patients. As expected, there was a significant decrease in 8-year DFS and OS in patients with pN1 disease in the SN.

Supported by the Leslie and Susan Gonda (Goldschmied) Foundation, Los Angeles, CA; the Associates for Breast and Prostate Cancer Studies, Santa Monica, CA; and QVC and the Fashion Footwear Charitable Foundation, New York, NY.

Presented at the 30th Annual San Antonio Breast Cancer Symposium, December 13-16, 2007, San Antonio, TX.

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

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