Cytokeratin staining and other sentinel node controversies

Research output: Contribution to journalArticle

Abstract

Sentinel lymph node (SLN) biopsy for breast cancer staging has been widely accepted because it is more sensitive and less morbid than axillary dissection. Sentinel nodes can be thoroughly scrutinized using a variety of techniques increasing the detection of micrometastases; however, the clinical relevance of micrometastases has been challenged. The available data suggest that the prognostic significance of axillary metastases is related to the size of the metastases, and the best data suggest that outcome for patients with metastases <0.2 mm is similar to patients with node-negative disease. This would argue against the use of ultrasensitive tests such as reverse transcriptase polymerase chain reaction. Immunohistochemistry upstages 2%-20% of hematoxylin and eosin-negative sentinel nodes, and additional nodal metastases are identified in approximately 10% of completion axillary dissections prompted by an immunohistochemistry (IHC)-positive sentinel node. This would appear to be a good reason to perform IHC and act on the results. Because micrometastases can be artifactual, SLN biopsy in ductal carcinoma in situ can lead to harmful overtreatment and is best performed in the context of clinical trials. Lymphoscintigraphy has allowed the detection of alternate drainage patterns to internal mammary, infraclavicular, and supraclavicular lymph nodes. Although patients are occasionally identified who have metastases to these basins but not the axilla, this information will not impact the decision for chemotherapy in most cases. Internal mammary SLN biopsy may have value in patients with tumors <1 cm, but requires additional evaluation in clinical trials.

Original languageEnglish (US)
JournalClinical Breast Cancer
Volume4
Issue numberSUPPL. 1
StatePublished - 2003
Externally publishedYes

Fingerprint

Keratins
Sentinel Lymph Node Biopsy
Neoplasm Micrometastasis
Staining and Labeling
Neoplasm Metastasis
Immunohistochemistry
Dissection
Breast
Clinical Trials
Lymphoscintigraphy
Axilla
Carcinoma, Intraductal, Noninfiltrating
Neoplasm Staging
Hematoxylin
Eosine Yellowish-(YS)
Reverse Transcriptase Polymerase Chain Reaction
Drainage
Lymph Nodes
cyhalothrin
Breast Neoplasms

Keywords

  • Breast neoplams
  • Cytokeratin-19
  • Ductal carcinoma in situ
  • Immunohistochemistry
  • Internal mammary nodes
  • Micrometastases
  • Reverse transcriptase polymerase chain reaction

ASJC Scopus subject areas

  • Cancer Research

Cite this

Cytokeratin staining and other sentinel node controversies. / Euhus, David M.

In: Clinical Breast Cancer, Vol. 4, No. SUPPL. 1, 2003.

Research output: Contribution to journalArticle

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