Bone marrow staging for breast cancer: is it better than axillary node dissection?

Abstract

Numerous studies have shown tumor cells in bone marrow to be a new and independent prognostic factor in primary breast cancer. The presence of such cytokeratin-positive or mucin-positive cells reflects the biology and systemic character of breast cancer much better than lymph node status. Axillary lymphadenectomy is associated with a considerable number of complications and is completely unnecessary in about 50% of cases (in node-negative patients). Whether axillary node dissection contributes to improved survival is highly controversial. However, since nearly all patients with primary breast cancer now receive adjuvant systemic therapy, the value of the classic prognostic factors must be discussed and re-evaluated. Much information can now be determined from primary tumor (HER-2/neu, etc). Tumor cell detection in bone marrow is a simple method that can be performed on an outpatient basis and that can be repeated if necessary (for monitoring therapy). The main disadvantage of the technique is that it has not been possible to standardize the laboratory methods and to find the ideal antibody--one that is not only able to recognize an epithelial cell, but which can also describe its metastatic potential. Semin Oncol 28:236-244.