Modes of benign mechanical transport of breast epithelial cells to axillary lymph nodes.
The status of axillary lymph nodes is a key prognostic indicator available for the management of patients with breast cancer. Sentinel lymph node (SLN) evaluation as a predictor of lymph node status has led to increased use of ancillary methods, principally immunohistochemistry, to increase the sensitivity of the SLN biopsy. So-called "occult" micrometastases detected by such methods have led to speculation that some may have reached the SLNs by benign mechanical transport (BMT) rather than a metastatic process. We review evidence suggesting two potential modes of BMT: lymphatic transport of epithelial cells displaced by biopsy of the primary breast tumor and by breast massage-assisted SLN localization. The biopsy techniques under most scrutiny include fine needle aspiration and large-gauge core biopsy. The evidence implicating breast massage prior to SLN biopsy as a mode of BMT has been supported by statistical analysis; however, no method of distinguishing massage-associated cells in SLNs from true occult micrometastases is available. The significance of small epithelial clusters in SLNs is currently unknown. Thus, deviation from current biopsy and SLN-localizing practices is unwarranted.
Diaz
Nils M
NM
Department of Interdisciplinary Oncology, H. Lee Moffitt Cancer Center, 12902 Magnolia Dr., Rm. 2071, Tampa, FL 33612, USA. diaznm@moffitt.usf.edu
Vrcel
Vesna
V
Centeno
Barbara A
BA
Muro-Cacho
Carlos
C
D001365:Axilla / Q000473:pathology; D001706:Biopsy / Q000009:adverse effects; D001943:Breast Neoplasms / Q000473:pathology*; D004847:Epithelial Cells / Q000473:pathology*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008405:Massage / Q000009:adverse effects