title: Sinusal localization of nodal micrometastases is a prognostic factor in breast cancer.
abstract: BACKGROUND
  Breast cancer micrometastases are frequently found during pathological examination of sentinel lymph nodes and complete axillary lymph node dissection. Despite this, their clinical relevance is still debated. The aim of this study is to investigate features that affect disease-free survival (DFS) and overall survival (OS) in patients with nodal micrometastases from breast cancer.
  
  
  METHODS
  We retrospectively investigated the outcome of 122 patients with nodal micrometastases from breast cancer followed up for 60 months.
  
  
  RESULTS
  At univariate analysis, worse DFS was related to features of primary tumor (multifocality P = 0.002; size >2 cm, P = 0.022; grade P = 0.022; absence of estrogen P < 0.001 and progesterone P < 0.001 receptors; HER-2 overexpression P = 0.006; vascular invasion P = 0.039; proliferative fraction > or =20% P = 0.034) and micrometastases (sinusal localization P = 0.010). Among the above-mentioned features, two were strongly associated with worse DFS in the multivariate model, i.e. negative receptorial status [hazard ratio (HR) = 11.24, 95% confidence interval (CI) 4.06-31.09; P < 0.001] and sinusal localization of micrometastasis (HR = 3.66, 1.18-11.36; P = 0.025). The OS was influenced by multifocality (P < 0.001) and receptor status (P = 0.005).
  
  
  CONCLUSIONS
  Our results indicate that in patients affected by breast cancer, in addition to the well-known pathological features of primary tumor, sinusal localization of micrometastasis strongly impacts on the prognosis.
authors.affiliation: Department of Oncology and Hematology, Istituto Clinico Humanitas IRCCS. Electronic address: giovanna.masci@humanitas.it.
authors.forename: G
authors.initials: G
authors.lastname: Masci
authors.affiliation: Department of Pathology, Istituto Clinico Humanitas IRCCS, University of Milan School of Medicine, Rozzano (Milano).
authors.forename: L
authors.initials: L
authors.lastname: Di Tommaso
authors.affiliation: Breast Unit, Department of Surgery, Humanitas Gavazzeni, Bergamo.
authors.forename: I
authors.initials: I
authors.lastname: Del Prato
authors.affiliation: Unit of Senology, Department of Oncology and Hematology.
authors.forename: S
authors.initials: S
authors.lastname: Orefice
authors.affiliation: Unit of Senology, Department of Oncology and Hematology.
authors.forename: A
authors.initials: A
authors.lastname: Rubino
authors.affiliation: Department of Oncology and Hematology, Istituto Clinico Humanitas IRCCS.
authors.forename: G
authors.initials: G
authors.lastname: Gullo
authors.affiliation: Department of Oncology and Hematology, Istituto Clinico Humanitas IRCCS.
authors.forename: M
authors.initials: M
authors.lastname: Zuradelli
authors.affiliation: Breast Unit, Department of Surgery, Humanitas Gavazzeni, Bergamo.
authors.forename: R
authors.initials: R
authors.lastname: Sacco
authors.affiliation: Unit of Thoracic Surgery.
authors.forename: M
authors.initials: M
authors.lastname: Alloisio
authors.affiliation: Unit of Senology, Department of Oncology and Hematology.
authors.forename: M
authors.initials: M
authors.lastname: Eboli
authors.affiliation: Unit of Thoracic Surgery.
authors.forename: M
authors.initials: M
authors.lastname: Incarbone
authors.affiliation: Medical Statistics Office, Istituto Clinico Humanitas IRCCS, Rozzano (Milano), Italy.
authors.forename: L
authors.initials: L
authors.lastname: Giordano
authors.affiliation: Department of Pathology, Istituto Clinico Humanitas IRCCS, University of Milan School of Medicine, Rozzano (Milano).
authors.forename: M
authors.initials: M
authors.lastname: Roncalli
authors.affiliation: Department of Oncology and Hematology, Istituto Clinico Humanitas IRCCS.
authors.forename: A
authors.initials: A
authors.lastname: Santoro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology*; D002277:Carcinoma / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D014018:Tissue Distribution; D047368:Tumor Burden