Effect of Occult Metastases on Survival in Node-Negative Breast Cancer

• Published in: The New England journal of medicine Vol. 364; no. 5; pp. 412 - 421
• Main Authors: Weaver, Donald L, Ashikaga, Takamaru, Krag, David N, Skelly, Joan M, Anderson, Stewart J, Harlow, Seth P, Julian, Thomas B, Mamounas, Eleftherios P, Wolmark, Norman
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 03.02.2011
• Subjects: Axilla; Biological and medical sciences; Biopsy; Breast cancer; Breast Neoplasms - mortality; Breast Neoplasms - pathology; Breast Neoplasms - therapy; Cohort Studies; Disease-Free Survival; Dissection; Female; General aspects; Gynecology. Andrology. Obstetrics; Humans; Kaplan-Meier Estimate; Lymph Node Excision; Lymph Nodes - pathology; Lymphatic Metastasis - pathology; Lymphatic system; Mammary gland diseases; Medical sciences; Middle Aged; Prognosis; Sentinel Lymph Node Biopsy; Treatment Failure; Tumors; Medicine; Mammary gland diseases; Breast disease; Early stage; Breast cancer; Mammary gland; Metastasis; Malignant tumor; Survival; Cancer
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMoa1008108

The authors detected isolated tumor-cell clusters in otherwise negative nodes in 16% of women with breast cancer. The 5-year estimates of survival were 94.6% among women with occult nodal spread and 95.8% among those without occult nodal spread. A landmark 1948 article by Saph and Amromin showed that the routine analysis of lymph nodes in breast cancer was insufficient to detect all metastases present. 1 Although the practice of additional pathological analysis was not adopted, the concept of occult metastases (metastases that are not detected initially but are detected with further evaluation) was introduced and has been the subject of considerable research and controversy over the ensuing decades. 2 – 4 The National Surgical Adjuvant Breast and Bowel Project (NSABP) trial B-32 was designed to evaluate whether sentinel-lymph-node biopsy alone was equivalent to complete axillary dissection with respect to overall survival . . .