Introduction
The role of immunohistochemistry (IHC) for detecting occult lymph node disease in
patients initially found to be node-negative by routine pathology is controversial.
In this study, we evaluated trends associated with overall survival in node-negative
breast cancer patients staged by IHC.
Methods
The Surveillance, Epidemiology, and End Results database was queried for all patients
with invasive breast adenocarcinoma and negative lymph nodes on routine pathology
between 2004 and 2011 who underwent IHC to evaluate for occult nodal disease. Overall
survival stratified by N-stage was compared with Kaplan-Meier analysis. Multivariate
analysis was performed using a Cox proportional hazards model.
Results
Overall, 93,070 patients were identified, including 4,657 patients with isolated tumor
cells (<0.2 mm diameter or <200 cells) and 6,720 patients with micrometastases (0.2–2 mm
diameter). Kaplan-Meier curves demonstrated a difference in overall survival across
all groups (P < .0001). On multivariate analysis, micrometastases remained an independent predictor
for survival compared with IHC-negative patients (hazard ratio 1.40, 95% confidence
interval 1.28–1.53), whereas isolated tumor cells were not a significant predictor
(hazard ratio 1.05, 95% confidence interval 0.92–1.20).
Conclusion
Patients with occult micrometastases in axillary lymph nodes found via IHC demonstrated
a significant overall survival difference, but isolated tumor cells have no prognostic
significance.
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Article info
Publication history
Published online: May 29, 2015
Accepted:
March 18,
2015
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
