title: Benign mechanical transport of breast epithelial cells to sentinel lymph nodes.
abstract: The evaluation of sentinel lymph nodes (SLNs) for the presence of malignant epithelial cells is essential to the staging of breast cancer patients. Recently, increased attention has focused on the possibility that epithelial cells may reach SLNs by benign mechanical means, rather than by metastasis. The purpose of this study was to test the hypothesis that pre-SLN biopsy breast massage, which we currently use to facilitate the localization of SLNs, might represent a mode of benign mechanical transport. We studied 56 patients with invasive and/or in situ ductal carcinoma and axillary SLNs with only epithelial cells and/or cell clusters (< or =0.2 mm in diameter and not associated with features of established metastases) detected predominantly in subcapsular sinuses of SLNs on hematoxylin and eosin- and/or anti-cytokeratin-stained sections. No patient had an SLN involved by either micro- or macro-metastatic carcinoma. Epithelial cells and cell clusters, < or =0.2 mm in size and without features of established metastases, occurred more frequently in the SLNs of patients who underwent pre-SLN biopsy breast massage (P < 0.001, chi2 test). The latter finding supports the hypothesis that pre-SLN biopsy breast massage is a mode of benign mechanical transport of epithelial cells to SLNs.
authors.affiliation: Department of Interdisciplinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL 33612, USA. diaznm@moffitt.usf.edu
authors.forename: Nils M
authors.initials: NM
authors.lastname: Diaz
authors.forename: Charles E
authors.initials: CE
authors.lastname: Cox
authors.forename: Mark
authors.initials: M
authors.lastname: Ebert
authors.forename: John D
authors.initials: JD
authors.lastname: Clark
authors.forename: Vesna
authors.initials: V
authors.lastname: Vrcel
authors.forename: Nicholas
authors.initials: N
authors.lastname: Stowell
authors.forename: Anu
authors.initials: A
authors.lastname: Sharma
authors.forename: James W
authors.initials: JW
authors.lastname: Jakub
authors.forename: Alan
authors.initials: A
authors.lastname: Cantor
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Centeno
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Dupont
authors.forename: Carlos
authors.initials: C
authors.lastname: Muro-Cacho
authors.forename: Santo
authors.initials: S
authors.lastname: Nicosia
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D044584:Carcinoma, Ductal / Q000473:pathology / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000601:surgery; D004847:Epithelial Cells / Q000166:cytology* / Q000473:pathology; D006801:Humans; D008198:Lymph Nodes / Q000166:cytology* / Q000601:surgery; D008405:Massage; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000379:methods