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Poorer Breast Cancer Survival Associated With Micrometastases in Axillary Lymph Nodes OXFORD, United Kingdom -- March 1, 2010 -- Metastases <=2 mm in diameter, micrometastases, in axillary lymph nodes detected on examination of a single section of the lymph nodes appear to be associated with poorer disease-free and overall survival in patients with breast cancer, according to a study published online in the Journal of the National Cancer Institute. The prognostic relevance of isolated tumour cells and micrometastases in lymph nodes in patients with breast cancer has become a major issue since the introduction of the sentinel lymph node procedure. Recently, patients with minimal lymph node involvement detected after a sentinel node procedure in the Dutch MIRROR study were found to have a reduced disease-free survival. To better understand this issue, Maaike de Boer, MD, and Vivianne C.G. Tjan-Heijnen, MD, Division of Medical Oncology, at Maastricht University Medical Centre, Maastricht, the Netherlands, and colleagues performed a systematic review of literature published between 1977 and 2008 on the association of isolated tumourr cells and micrometastases in axillary lymph nodes and survival. A total of 58 articles were included and divided into 3 categories according to the methods used to detect the small metastases: cohort studies with single-section pathological examination of axillary lymph nodes; occult metastases studies with retrospective examination of negative lymph nodes by step sectioning and/or immunohistochemistry; and sentinel lymph node biopsy studies with intensified work-up of the sentinel but not of the non-sentinel lymph nodes. The presence, versus the absence, of metastases that were 2 mm or less in diameter was associated with poorer overall survival among cohort studies and with poorer overall survival and poorer disease-free survival among occult metastases studies. SOURCE: Journal of the National Cancer Institute E-mail this page to a friend or colleague! To print, use this version