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. 2008 Dec;15(12):3369-77.
doi: 10.1245/s10434-008-0153-2. Epub 2008 Sep 25.

Lymphovascular invasion and lobular histology are associated with increased incidence of isolated tumor cells in sentinel lymph nodes from early-stage breast cancer patients

Elizabeth A Mittendorf  1 , Aysegul A Sahin, Susan L Tucker, Funda Meric-Bernstam, Min Yi, Khazi M Nayeemuddin, Gildy V Babiera, Merrick I Ross, Barry W Feig, Henry M Kuerer, Kelly K Hunt
Affiliations

Lymphovascular invasion and lobular histology are associated with increased incidence of isolated tumor cells in sentinel lymph nodes from early-stage breast cancer patients

Elizabeth A Mittendorf et al. Ann Surg Oncol. 2008 Dec.

Abstract

Background: Isolated tumor cells (ITC) are more likely to be identified when serial sectioning and immunohistochemical staining are used to evaluate sentinel lymph nodes (SLN). Our goal was to identify clinicopathologic features associated with ITC in patients undergoing sentinel lymph node dissection (SLND).

Methods: We reviewed clinicopathologic data for 3557 patients with no clinical evidence of lymph node metastases undergoing SLND between November 1993 and March 2007. Patients were staged according to the 6th edition of the American Joint Committee on Cancer staging system, with metastasis <or=.2 mm classified as ITC.

Results: A SLN was identified in 3475 patients (97.7%), including 2518 (72.4%) with negative nodes and 169 (4.9%) with ITC. A statistically significant association existed between lobular histology and the identification of ITC; 13.6% of patients with ITC had lobular histology versus 7.3% of patients with a negative SLN (P = .003). The presence of lymphovascular invasion (LVI) was also associated with ITC; 18.3% of patients with ITC had LVI in the primary tumor versus 8.5% of patients with a negative SLN (P < .001). No difference existed between patients with and without ITC with respect to T stage, grade, estrogen receptor, progesterone receptor, HER2/neu status, or biopsy method.

Conclusion: The association between ITC and LVI, a known predictor of poor outcome, suggests ITC may have clinical relevance. The relationship between lobular histology and ITC is consistent with the known pattern of lobular metastases, which frequently present as small foci requiring immunohistochemistry for detection. Longer follow-up is needed to determine whether ITC have prognostic significance.

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Figures

Fig. 1
Fig. 1
Lobular histology and lymphovascular invasion (LVI) in the primary tumor are associated with the detection of isolated tumor cells (ITC) in patients with early-stage breast cancer. (A) Hematoxylin and eosin (H&E) staining of a tumor from a patient with early-stage breast cancer demonstrating lobular histology. (B) Immunohistochemical (IHC) staining for cytokeratin of a sentinel lymph node (SLN) from the same patient demonstrates scattered foci of ITC staining brown. (C) H&E staining of a second patient's primary tumor demonstrating LVI. (D) IHC performed on the SLN from the second patient showing ITC.
Fig. 2
Fig. 2
Increasing sentinel lymph node (SLN) tumor burden is associated with a greater likelihood of lymphovascular invasion (LVI) in the primary tumor. Within each pathologic category for SLNs obtained from patients with early-stage breast cancer, we determined the percentage of patients with LVI present in the primary tumor. The percentage of patients with LVI in their primary tumors increased significantly with increasing tumor burden in the SLN (P < .001).
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