The use of cytokeratin staining in sentinel lymph node biopsy for breast cancer

Am J Surg. 2001 Oct;182(4):330-4. doi: 10.1016/s0002-9610(01)00722-x.


Background: Controversy exists regarding the routine use of cytokeratin immunohistochemistry (IHC) in the histopathologic examination of breast cancer sentinel lymph nodes (SLN) because the clinical significance of micrometastases detected by IHC is unclear. This analysis was performed to determine the frequency of IHC-detected micrometastases.

Methods: All patients underwent SLN biopsy, followed by completion axillary dissection. This analysis included patients who had SLN evaluated by IHC. SLN were examined by hematoxylin and eosin (H&E) stain at 2-mm intervals, with IHC in 2 sections. The axillary dissection specimen was evaluated by routine H&E staining.

Results: IHC was performed in SLNs from 973 patients. Of the 869 patients with negative nodes by H&E, 58 (6.7%) were "upstaged" by IHC. In 6 of 58 patients (10.3%) who had IHC-only positive SLN, nodal metastases were found in the axillary dissection specimen.

Conclusions: IHC resulted in upstaging of 6.7% of patients who had negative SLN on H&E staining. These patients had a 10.3% risk of residual axillary nodal metastases. However, the clinical significance of IHC-only positive SLN requires further study.

Publication types

  • Multicenter Study

MeSH terms

  • Axilla
  • Breast Neoplasms / diagnosis
  • Breast Neoplasms / pathology*
  • Female
  • Humans
  • Immunohistochemistry
  • Keratins / analysis*
  • Lymphatic Metastasis / diagnosis*
  • Middle Aged
  • Sentinel Lymph Node Biopsy*


  • Keratins