title: Impact of micrometastases in the sentinel node of patients with invasive breast cancer.
abstract: OBJECTIVE
  Lymph node metastases are the most significant prognostic indicator for patients with breast cancer. Sentinel node biopsy (SNB) has led to an increase in the detection of micrometastases in the sentinel node (SN). This prospective study was designed to determine the survival impact of micrometastases in SNs of patients with invasive breast cancer. This study is based on the new sixth edition of the American Joint Committee on Cancer (AJCC) staging criteria.
  
  
  METHODS
  Between January 1, 1992 and April 30, 1999, 790 patients entered this prospective study at the John Wayne Cancer Institute. The SN was examined first by hematoxylin and eosin (HE), and if the SN was negative with HE, then immunohistochemical staining was performed. The patients were then divided into four groups based on AJCC nodal staging: pN0(i-), no evidence of tumor (n = 486); pN0(i+), tumor deposit < or = 0.2 mm (n = 84); pN1mi, tumor deposit more than 0.2 mm but < or = 2 mm (n = 54), and pN1, tumor deposit more than 2 mm (n = 166). Disease-free survival (DFS) and overall survival (OS) were estimated using the Kaplan-Meier method. The log-rank test was used to determine differences in DFS and OS of patients from different groups.
  
  
  RESULTS
  At a median follow-up of 72.5 months, the size of SN metastases was a significant predictor of DFS and OS.
  
  
  CONCLUSIONS
  Patients with micrometastatic tumor deposits, pN0(i+) or pN1mi, do not seem to have a worse 8-year DFS or OS compared with SN-negative patients. As expected, there was a significant decrease in 8-year DFS and OS in patients with pN1 disease in the SN.
authors.affiliation: John Wayne Cancer Institute, Santa Monica, CA 90404, USA.
authors.forename: Nora M
authors.initials: NM
authors.lastname: Hansen
authors.forename: Baiba
authors.initials: B
authors.lastname: Grube
authors.forename: Xing
authors.initials: X
authors.lastname: Ye
authors.forename: Roderick R
authors.initials: RR
authors.lastname: Turner
authors.forename: R James
authors.initials: RJ
authors.lastname: Brenner
authors.forename: Myung-Shin
authors.initials: MS
authors.lastname: Sim
authors.forename: Armando E
authors.initials: AE
authors.lastname: Giuliano
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000379:methods* / Q000706:statistics & numerical data