title: Impact of CD44+CD24- cells on non-sentinel axillary lymph node metastases in sentinel node-positive breast cancer.
abstract: Although complete axillary lymph node dissection (ALND) is the standard for evaluating axillary status after the identification of a positive sentinel lymph node (SLN) in breast cancer; approximately 40-60% of SLN-positive patients have negative non-SLN. In this study, to explore putative breast cancer stem cells with CD44+CD24- in the SLN, we retrospectively analyzed the expression of CD44+CD24- on metastatic tumor cells within SLNs as a predictive factor for positive non-SLNs (NSLNs). We tested 271 patients for SLNs using serial sectioning with cytokeratin immunohistochemistry (IHC) and hematoxylin-eosin staining and identified 67 patients who had a positive SLN biopsy and complete ALND. CD44 and CD24 expression was detected using double-staining IHC. Twenty-eight (41.8%) out of 67 patients had positive NSLN metastases. Seven positive SLNs with micrometastases were not available for the evaluation of CD24 and CD44 expression. Out of the remaining 60 patients, 19 (31.7%), 44 (73.83%) and 37 (61.7%) patients had CD24+, CD44+ and CD44+CD24- metastatic tumor cells in SLNs, respectively. Positive NSLN metastasis was significantly associated with the primary tumor size (P=0.004), CD24- expression (P=0.04), CD44+ expression (P=0.01) and CD44+CD24- expression (P=0.02). This report provides the first evidence of the existence of a putative stem-like phenotype within the SLN, which is significantly associated with positive NSLN in early breast cancer patients.
authors.affiliation: Department of Breast and Endocrine Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan. nogi_h@jikei.ac.jp
authors.forename: Hiroko
authors.initials: H
authors.lastname: Nogi
authors.forename: Masafumi
authors.initials: M
authors.lastname: Suzuki
authors.forename: Makiko
authors.initials: M
authors.lastname: Kamio
authors.forename: Kumiko
authors.initials: K
authors.lastname: Kato
authors.forename: Kazumi
authors.initials: K
authors.lastname: Kawase
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Toriumi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takeyama
authors.forename: Hisaki
authors.initials: H
authors.lastname: Fukushima
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Morikawa
authors.forename: Ken
authors.initials: K
authors.lastname: Uchida
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000378:metabolism / Q000556:secondary*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000378:metabolism / Q000473:pathology*; D051927:CD24 Antigen / Q000378:metabolism*; D018270:Carcinoma, Ductal, Breast / Q000378:metabolism / Q000556:secondary*; D018275:Carcinoma, Lobular / Q000378:metabolism / Q000556:secondary*; D005260:Female; D006801:Humans; D018960:Hyaluronan Receptors / Q000378:metabolism*; D007124:Immunoenzyme Techniques; D008198:Lymph Nodes; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D014411:Neoplastic Stem Cells / Q000378:metabolism / Q000473:pathology*; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy
chemical_list: D051927:CD24 Antigen; D018960:Hyaluronan Receptors