Occult metastases in sentinel nodes of 200 patients with operable breast cancer

Ann Surg Oncol. 2001 Sep;8(8):675-81. doi: 10.1007/s10434-001-0675-3.


Background: Up to 30% of patients with operable breast cancer and negative regional lymph nodes experience disease recurrence within 10 years. Serial sectioning and immunohistochemical staining of these nodes have revealed 9% to 30% occult metastases.

Methods: Sentinel nodes from 200 patients with T1 and T2 invasive breast carcinoma were step-sectioned at 2- to 3-mm intervals, fixed in 10% formalin, and embedded in paraffin. Sections were taken from the face of the blocks and stained with hematoxylin and eosin (H&E). The blocks were then cut completely, and sections at .25-mm intervals were stained with cytokeratin and examined.

Results: Tumor metastases were found in 34 patients when the sentinel nodes were examined at 2- to 3-mm intervals and in an additional 51 patients when the nodes were sectioned in their entirety at .25-mm intervals and stained with cytokeratin, bringing the total number of patients with metastases to 85. Of the 51 patients whose metastases were detected by 2- to 3-mm sectioning and cytokeratin staining, 27 had isolated tumor cells and 24 had clusters of innumerable malignant cells, all of which were visualized and confirmed by H&E staining of the adjacent sections.

Conclusions: Histologic examination of sentinel nodes of patients with invasive breast cancer sectioned at 2- to 3-mm intervals and stained with H&E significantly underestimates nodal metastases. Sectioning of the entire sentinel nodes at .25-mm intervals and staining with cytokeratin detects metastases as either isolated cells or as clusters.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biopsy, Needle
  • Breast Neoplasms / pathology*
  • Breast Neoplasms / surgery
  • Carcinoma / pathology*
  • Carcinoma / secondary*
  • Carcinoma / surgery
  • Culture Techniques
  • Female
  • Humans
  • Lymph Nodes / pathology*
  • Lymphatic Metastasis
  • Middle Aged
  • Neoplasm Staging
  • Prospective Studies
  • Sensitivity and Specificity
  • Sentinel Lymph Node Biopsy / methods*