Minimal metastatic disease in sentinel lymph nodes in breast carcinoma: Some modest proposals to refine criteria for "isolated tumor cells"

Bijal D. Amin, Syed A. Hoda

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Axillary lymph node status is one of the most important prognostic factors in breast carcinoma. The weight of cumulative evidence suggests that the development of the sentinel lymph node (SLN) biopsy procedure has not only allowed for accurate lymph node-staging but has also helped avoid the morbidity of a full axillary dissection in those patients who are unlikely to have metastatic tumor in that location. The detection of metastases in SLNs is facilitated by the, now relatively routine, enhanced histopathologic examination via step-sectioning and immunohistochemistry. In clinical terms, the finding of a metastatic deposit that measures between 0.2 and 2 mm, that is, "micrometastasis" in a SLN is largely noncontroversial; however, the presence of smaller metastatic foci detected either by routine hematoxylin and eosin stain or by cytokeratin immunostain [<0.2 mm, ie, so-called "isolated tumor cells (ITCs)"] has remained problematic since the advent of the SLN biopsy. In this communication, attention is drawn to the broad morphologic range of metastatic disease in SLN that may be placed in the category of so-called ITC. To facilitate the reproducible classification of the various strata of minimal metastasis in sentinel lymph nodes, we recommend the following: (1) the term "isolated tumor cell" (note singular form) be restricted to cases that show the presence of only a single tumor cell. (2) In situations where there are multiple isolated single cells and/or cell cluster(s) present and each cluster measures<0.2 mm, the term "submicroscopic metastasis" be adopted and an actual count of tumor cells present may be given. (3) Restrict the use of the term micrometastasis to cases wherein the largest metastatic focus is larger than 0.2 mm but smaller than 2.0 mm.

Original languageEnglish (US)
Pages (from-to)185-189
Number of pages5
JournalAdvances in Anatomic Pathology
Volume13
Issue number4
DOIs
StatePublished - Jul 2006
Externally publishedYes

Fingerprint

Breast Neoplasms
Sentinel Lymph Node Biopsy
Neoplasms
Neoplasm Micrometastasis
Neoplasm Metastasis
Lymph Nodes
Hematoxylin
Eosine Yellowish-(YS)
Keratins
Sentinel Lymph Node
Dissection
Coloring Agents
Cell Count
Immunohistochemistry
Morbidity
Weights and Measures

Keywords

  • Breast
  • Breast carcinoma
  • Carcinoma
  • Cytokeratin
  • Immunohistochemistry
  • Isolated tumor cells
  • Micrometastasis
  • Sentinel lymph node
  • Submicrometastasis
  • Tumor stage

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Anatomy

Cite this

@article{5ad8050756a14938acbb308efffcbc6b,
title = "Minimal metastatic disease in sentinel lymph nodes in breast carcinoma: Some modest proposals to refine criteria for {"}isolated tumor cells{"}",
abstract = "Axillary lymph node status is one of the most important prognostic factors in breast carcinoma. The weight of cumulative evidence suggests that the development of the sentinel lymph node (SLN) biopsy procedure has not only allowed for accurate lymph node-staging but has also helped avoid the morbidity of a full axillary dissection in those patients who are unlikely to have metastatic tumor in that location. The detection of metastases in SLNs is facilitated by the, now relatively routine, enhanced histopathologic examination via step-sectioning and immunohistochemistry. In clinical terms, the finding of a metastatic deposit that measures between 0.2 and 2 mm, that is, {"}micrometastasis{"} in a SLN is largely noncontroversial; however, the presence of smaller metastatic foci detected either by routine hematoxylin and eosin stain or by cytokeratin immunostain [<0.2 mm, ie, so-called {"}isolated tumor cells (ITCs){"}] has remained problematic since the advent of the SLN biopsy. In this communication, attention is drawn to the broad morphologic range of metastatic disease in SLN that may be placed in the category of so-called ITC. To facilitate the reproducible classification of the various strata of minimal metastasis in sentinel lymph nodes, we recommend the following: (1) the term {"}isolated tumor cell{"} (note singular form) be restricted to cases that show the presence of only a single tumor cell. (2) In situations where there are multiple isolated single cells and/or cell cluster(s) present and each cluster measures<0.2 mm, the term {"}submicroscopic metastasis{"} be adopted and an actual count of tumor cells present may be given. (3) Restrict the use of the term micrometastasis to cases wherein the largest metastatic focus is larger than 0.2 mm but smaller than 2.0 mm.",
keywords = "Breast, Breast carcinoma, Carcinoma, Cytokeratin, Immunohistochemistry, Isolated tumor cells, Micrometastasis, Sentinel lymph node, Submicrometastasis, Tumor stage",
author = "Amin, {Bijal D.} and Hoda, {Syed A.}",
year = "2006",
month = "7",
doi = "10.1097/00125480-200607000-00005",
language = "English (US)",
volume = "13",
pages = "185--189",
journal = "Advances in Anatomic Pathology",
issn = "1072-4109",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Minimal metastatic disease in sentinel lymph nodes in breast carcinoma

T2 - Some modest proposals to refine criteria for "isolated tumor cells"

AU - Amin, Bijal D.

AU - Hoda, Syed A.

PY - 2006/7

Y1 - 2006/7

N2 - Axillary lymph node status is one of the most important prognostic factors in breast carcinoma. The weight of cumulative evidence suggests that the development of the sentinel lymph node (SLN) biopsy procedure has not only allowed for accurate lymph node-staging but has also helped avoid the morbidity of a full axillary dissection in those patients who are unlikely to have metastatic tumor in that location. The detection of metastases in SLNs is facilitated by the, now relatively routine, enhanced histopathologic examination via step-sectioning and immunohistochemistry. In clinical terms, the finding of a metastatic deposit that measures between 0.2 and 2 mm, that is, "micrometastasis" in a SLN is largely noncontroversial; however, the presence of smaller metastatic foci detected either by routine hematoxylin and eosin stain or by cytokeratin immunostain [<0.2 mm, ie, so-called "isolated tumor cells (ITCs)"] has remained problematic since the advent of the SLN biopsy. In this communication, attention is drawn to the broad morphologic range of metastatic disease in SLN that may be placed in the category of so-called ITC. To facilitate the reproducible classification of the various strata of minimal metastasis in sentinel lymph nodes, we recommend the following: (1) the term "isolated tumor cell" (note singular form) be restricted to cases that show the presence of only a single tumor cell. (2) In situations where there are multiple isolated single cells and/or cell cluster(s) present and each cluster measures<0.2 mm, the term "submicroscopic metastasis" be adopted and an actual count of tumor cells present may be given. (3) Restrict the use of the term micrometastasis to cases wherein the largest metastatic focus is larger than 0.2 mm but smaller than 2.0 mm.

AB - Axillary lymph node status is one of the most important prognostic factors in breast carcinoma. The weight of cumulative evidence suggests that the development of the sentinel lymph node (SLN) biopsy procedure has not only allowed for accurate lymph node-staging but has also helped avoid the morbidity of a full axillary dissection in those patients who are unlikely to have metastatic tumor in that location. The detection of metastases in SLNs is facilitated by the, now relatively routine, enhanced histopathologic examination via step-sectioning and immunohistochemistry. In clinical terms, the finding of a metastatic deposit that measures between 0.2 and 2 mm, that is, "micrometastasis" in a SLN is largely noncontroversial; however, the presence of smaller metastatic foci detected either by routine hematoxylin and eosin stain or by cytokeratin immunostain [<0.2 mm, ie, so-called "isolated tumor cells (ITCs)"] has remained problematic since the advent of the SLN biopsy. In this communication, attention is drawn to the broad morphologic range of metastatic disease in SLN that may be placed in the category of so-called ITC. To facilitate the reproducible classification of the various strata of minimal metastasis in sentinel lymph nodes, we recommend the following: (1) the term "isolated tumor cell" (note singular form) be restricted to cases that show the presence of only a single tumor cell. (2) In situations where there are multiple isolated single cells and/or cell cluster(s) present and each cluster measures<0.2 mm, the term "submicroscopic metastasis" be adopted and an actual count of tumor cells present may be given. (3) Restrict the use of the term micrometastasis to cases wherein the largest metastatic focus is larger than 0.2 mm but smaller than 2.0 mm.

KW - Breast

KW - Breast carcinoma

KW - Carcinoma

KW - Cytokeratin

KW - Immunohistochemistry

KW - Isolated tumor cells

KW - Micrometastasis

KW - Sentinel lymph node

KW - Submicrometastasis

KW - Tumor stage

UR - http://www.scopus.com/inward/record.url?scp=33748204185&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33748204185&partnerID=8YFLogxK

U2 - 10.1097/00125480-200607000-00005

DO - 10.1097/00125480-200607000-00005

M3 - Article

C2 - 16858152

AN - SCOPUS:33748204185

VL - 13

SP - 185

EP - 189

JO - Advances in Anatomic Pathology

JF - Advances in Anatomic Pathology

SN - 1072-4109

IS - 4

ER -