Micrometastases Affect Breast Cancer Prognosis

Among women with early breast cancer, those with very small areas of cancer (micrometastases) in the axillary lymph nodes tend to have a higher risk of recurrence than those whose lymph nodes are completely free of cancer. These results were published in the Journal of Clinical Oncology.

Evaluation of the axillary (under the arm) lymph nodes for the presence of cancer is an important part of breast cancer staging. To assess the axillary lymph nodes, a surgeon will perform either an axillary lymph node dissection, in which many lymph nodes are surgically removed and evaluated, or a less extensive procedure known as a sentinel lymph node biopsy.

For some women, evaluation of the lymph nodes will reveal very small areas of cancer. Areas of cancer that measure between 0.2 mm and 2.0 mm are referred to as “micrometastases.” Even smaller areas of cancer are referred to as “isolated tumor cells.” The clinical significance of lymph node micrometastases and isolated tumor cells has been uncertain but was evaluated in a study conducted in Sweden.

The study collected information about the treatment and outcomes of 3,369 breast cancer patients. A total of 2,383 were node-negative, 107 had isolated tumor cells in the axillary lymph nodes, 123 had micrometastases, and 756 had macrometastases (larger areas of cancer in the lymph nodes).

Five-year survival without cancer recurrence was 87.1% among women with no lymph node metastases, 88.9% among women with isolated tumor cells, 79.6% among women with micrometastases, and 80.1% among women with macrometastases. Compared with node-negative women, overall survival was not significantly worse among women with micrometastases or isolated tumor cells, but was worse among women with macrometastases.

These results suggest that women with lymph node micrometastases have a higher risk of breast cancer recurrence than women with cancer-free lymph nodes. Isolated tumor cells in the lymph nodes did not appear to affect outcomes in this population.

Reference:?

Andersson Y, Frisell J, Sylvan M, de Boniface J, Bergkvist L. Breast cancer survival in relation to the metastatic tumor burden in axillary lymph nodes. Journal of Clinical Oncology [early online publication]. May 10, 2010.

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Micrometastases in Sentinel Node Don’t Worsen Breast Cancer Survival

Detection of very small areas of cancer (micrometastases) in the sentinel lymph node through use of highly sensitive testing is not associated with breast cancer outcomes. These results were published in the Journal of the American Medical Association.??

For women with early breast cancer, determining whether the cancer has spread to the axillary (under the arm) lymph nodes is an important part of cancer staging. Many women initially undergo a sentinel lymph node biopsy, in which only a small number of nodes (or even a single node) is removed. If the sentinel nodes show evidence of cancer, many women then undergo additional lymph node removal.???

For some women, evaluation of the lymph nodes will reveal very small areas of cancer known as micrometastases. Whether these very small areas of cancer affect breast cancer outcomes has been uncertain.?

To explore the relationship between sentinel node micrometastases and breast cancer outcomes, researchers evaluated information from more than 5,100 women with early-stage breast cancer. Women were treated with breast-conserving surgery, sentinel lymph node biopsy, whole-breast radiation therapy, and (when appropriate) chemotherapy and/or hormonal therapy.?

Women whose sentinel nodes were cancer-free by conventional testing underwent additional, more sensitive testing in order to identify very small areas of cancer that were not detected by initial testing. Researchers also collected bone marrow samples in order to detect small areas of cancer in the bone.??

Of the sentinel nodes that tested negative (cancer-free) by conventional testing, 10.5% tested positive for micrometastases by more sensitive testing. The presence of micrometastases, however, did not affect overall survival or the risk of cancer recurrence. ?Three percent of the bone marrow samples tested positive for cancer. Although these patients appeared to have a shorter survival, the presence of cells in the bone marrow was not an independent predictor of survival.? In other words, the finding of tumor cells in the bone marrow did not provide additional information to assist in clinical decision-making.?Current approaches to breast cancer treatment may have contributed to the effective management of sentinel node micrometastases. A majority of the study participants received systemic therapy (chemotherapy +/- hormonal therapy).?

These results suggest that micrometastases in the sentinel nodes do not significantly affect the outcome of early-stage breast cancer. Highly sensitive testing to detect lymph node micrometastases does not appear to be warranted.???

At this time, based on the available data, women with early stage breast cancer should not have routine bone marrow aspirates to look for tumor cells.?

Reference: Giuliano AE, Hawes D, Ballman KV et al. Association of occult metastases in sentinel lymph nodes and bone marrow with survival among women with early-stage invasive breast cancer. Journal of the American Medical Association. 2011;306:385-393.?

Posted August 1, 2011

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