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Kim, Choi, Kim, Lee, Lim, Cho, Lee, Nam, and Yang: Implications of Isolated Tumor Cells in Sentinel Lymph Nodes of Breast Cancer Patients
Original Article
Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2009; 77(6): 378-384.

Published online: 4 December 2009

DOI: https://doi.org/10.4174/jkss.2009.77.6.378

Implications of Isolated Tumor Cells in Sentinel Lymph Nodes of Breast Cancer Patients

Gyunji Kim, M.D., Jae Hyuck Choi, M.D., Wan Wook Kim, M.D., Se Kyung Lee, M.D., Hye In Lim, M.D., Eun Yoon Cho, M.D., Ph.D.1, Jeong Eon Lee, M.D., Ph.D., Seok Jin Nam, M.D., Ph.D., Jung-Hyun Yang, M.D., Ph.D.

Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

1Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Corresponding author (drjh.yang@samsung.com)

Received 31 July 2009       Accepted 11 September 2009

Copyright © 2009 The Korean Surgical Society

Abstract

Purpose

Sentinel lymph node (SLN) biopsy has replaced unnecessary axillary dissection in breast cancer surgery except when the nodes are positive for macrometastasis. But guidelines for isolated tumor cells (ITCs) found in SLNs has not yet been established and further study is ongoing. The goal of this study was to consider the implication of the isolated tumor cells found in the SLNs of Korean breast cancer patients.

Methods

Between September 2003 and March 2008, 985 primary breast cancer patients underwent SLN biopsy. On reviewing the medical records, 81 patients were found to have ITCs in SLNs without macrometastasis or micrometastasis. ITCs were detected by serial sectioning and immunohistochemistry.

Results

The mean number of detected SLNs was 3.5±1.7. Thirty three patients had multifocally distributed ITCs and 9 had ITCs in multiple SLNs whose N stage was N0 (i+). Completion axillary dissection has been performed in 9 patients and 3 of them (33.3%) finally were found to be N1 or N1mi.

Conclusion

The characteristics of ITCs are not clear yet and their prognostic value is still under investigation. Until the significance of ITCs found in SLNs become definite, axillary dissection should be more aggressively considered.

Keywords: Breast cancer, Sentinel lymph node biopsy, Isolated tumor cells, Axillary dissection

Figures and Tables

Fig. 1
Axillary dissection over ITCs and final N stage. ITCs = isolated tumor cells; AD = axillary dissection.
jkss-77-378-g001
Table 1
Characteristics of the patients with isolated tumor cells
jkss-77-378-i001

*SLNB = sentinel lymph node biopsy; †AD = axillary dissection; ‡DCIS = ductal carcinoma in situ.

Table 2
Distribution of isolated tumor cells
jkss-77-378-i002

*LN = lymph node; †ITCs = isolated tumor cells; ‡Numbers in parentheses are the numbers of patients who underwent axillary dissection.

Table 3
Characteristics of the patients who underwent axillary dissection
jkss-77-378-i003

*ITCs = isolated tumor cells; †LNs = lymph nodes; ‡AD = axillary dissection; §Patients who was found ITCs at frozen biopsy; ∥MRM = modified radical mastectomy; IDC = invasive ductal carcinoma; **BCS = breast conserving mastectomy; ††SLNB = sentinel lymph node biopsy; ‡‡TM = total mastectomy.

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