Role of immunohistochemical detection of lymph-node metastases in management of breast cancer

R. J. Cote, H. F. Peterson, B. Chaiwun, R. D. Gelber, A. Goldhirsch, M. Castiglione-Gertsch, B. Gusterson, A. M. Neville

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Abstract

Background. This study was designed to ascertain whether immunohistochemical methods could improve the detection of metastases in primary breast-cancer patients whose axillary lymph nodes were classified, by conventional methods, as disease free. Methods. Ipsilateral lymph nodes (negative for metastases by routine histology) from 736 patients (participants in Trial V of the International [Ludwig] Breast Cancer Study) were examined by serial sectioning and staining with haematoxylin and eosin (two sections from each of six levels) and by immunohistochemistry of a single section (with two anticytokeratins AE-1 and CAM 5.2). After median follow-up of 12 years, disease-free and overall survival were estimated by Kaplan-Meier methods. Findings. Occult nodal metastases were detected by serial sectioning and haematoxylin and eosin in 52 (7%) of 736 patients and by immunohistochemistry in 148 (20%). Only two (3%) of 64 invasive lobular or mixed invasive lobular and ductal cancers had node micrometastases, detected by haematoxylin and eosin, compared with 25 (39%) by immunohistochemistry. Occult metastases, detected by either method, were associated with significantly poor disease-free and overall survival in postmenopausal but not in premenopausal patients. Immunohistochemically detected occult lymph-node metastases remained an independent and highly significant predictor of recurrence even after control for tumour grade, tumour size, oestrogen-receptor status, vascular invasion, and treatment assignment (hazard ratio 1.79 [95% CI 1.17-2.74], p = 0 007). Interpretation. The immunohistochemical examination of ipsilateral axillary lymph nodes is a reliable, prognostically valuable, and simple method for the detection of occult nodal metastases. Immunohistochemistry is recommended as a standard method of node examination in postmenopausal patients.

Original languageEnglish
Pages (from-to)896-900
Number of pages5
JournalLancet
Volume354
Issue number9182
DOIs
Publication statusPublished - Sep 11 1999

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Lymph Nodes
Breast Neoplasms
Neoplasm Metastasis
Hematoxylin
Eosine Yellowish-(YS)
Immunohistochemistry
Disease-Free Survival
Neoplasms
Neoplasm Micrometastasis
Estrogen Receptors
Blood Vessels
Histology
Staining and Labeling
Recurrence

ASJC Scopus subject areas

  • Medicine(all)

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Cote, R. J., Peterson, H. F., Chaiwun, B., Gelber, R. D., Goldhirsch, A., Castiglione-Gertsch, M., ... Neville, A. M. (1999). Role of immunohistochemical detection of lymph-node metastases in management of breast cancer. Lancet, 354(9182), 896-900. https://doi.org/10.1016/S0140-6736(98)11104-2

Role of immunohistochemical detection of lymph-node metastases in management of breast cancer. / Cote, R. J.; Peterson, H. F.; Chaiwun, B.; Gelber, R. D.; Goldhirsch, A.; Castiglione-Gertsch, M.; Gusterson, B.; Neville, A. M.

In: Lancet, Vol. 354, No. 9182, 11.09.1999, p. 896-900.

Research output: Contribution to journalArticle

Cote, RJ, Peterson, HF, Chaiwun, B, Gelber, RD, Goldhirsch, A, Castiglione-Gertsch, M, Gusterson, B & Neville, AM 1999, 'Role of immunohistochemical detection of lymph-node metastases in management of breast cancer', Lancet, vol. 354, no. 9182, pp. 896-900. https://doi.org/10.1016/S0140-6736(98)11104-2
Cote RJ, Peterson HF, Chaiwun B, Gelber RD, Goldhirsch A, Castiglione-Gertsch M et al. Role of immunohistochemical detection of lymph-node metastases in management of breast cancer. Lancet. 1999 Sep 11;354(9182):896-900. https://doi.org/10.1016/S0140-6736(98)11104-2
Cote, R. J. ; Peterson, H. F. ; Chaiwun, B. ; Gelber, R. D. ; Goldhirsch, A. ; Castiglione-Gertsch, M. ; Gusterson, B. ; Neville, A. M. / Role of immunohistochemical detection of lymph-node metastases in management of breast cancer. In: Lancet. 1999 ; Vol. 354, No. 9182. pp. 896-900.
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abstract = "Background. This study was designed to ascertain whether immunohistochemical methods could improve the detection of metastases in primary breast-cancer patients whose axillary lymph nodes were classified, by conventional methods, as disease free. Methods. Ipsilateral lymph nodes (negative for metastases by routine histology) from 736 patients (participants in Trial V of the International [Ludwig] Breast Cancer Study) were examined by serial sectioning and staining with haematoxylin and eosin (two sections from each of six levels) and by immunohistochemistry of a single section (with two anticytokeratins AE-1 and CAM 5.2). After median follow-up of 12 years, disease-free and overall survival were estimated by Kaplan-Meier methods. Findings. Occult nodal metastases were detected by serial sectioning and haematoxylin and eosin in 52 (7{\%}) of 736 patients and by immunohistochemistry in 148 (20{\%}). Only two (3{\%}) of 64 invasive lobular or mixed invasive lobular and ductal cancers had node micrometastases, detected by haematoxylin and eosin, compared with 25 (39{\%}) by immunohistochemistry. Occult metastases, detected by either method, were associated with significantly poor disease-free and overall survival in postmenopausal but not in premenopausal patients. Immunohistochemically detected occult lymph-node metastases remained an independent and highly significant predictor of recurrence even after control for tumour grade, tumour size, oestrogen-receptor status, vascular invasion, and treatment assignment (hazard ratio 1.79 [95{\%} CI 1.17-2.74], p = 0 007). Interpretation. The immunohistochemical examination of ipsilateral axillary lymph nodes is a reliable, prognostically valuable, and simple method for the detection of occult nodal metastases. Immunohistochemistry is recommended as a standard method of node examination in postmenopausal patients.",
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AU - Cote, R. J.

AU - Peterson, H. F.

AU - Chaiwun, B.

AU - Gelber, R. D.

AU - Goldhirsch, A.

AU - Castiglione-Gertsch, M.

AU - Gusterson, B.

AU - Neville, A. M.

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N2 - Background. This study was designed to ascertain whether immunohistochemical methods could improve the detection of metastases in primary breast-cancer patients whose axillary lymph nodes were classified, by conventional methods, as disease free. Methods. Ipsilateral lymph nodes (negative for metastases by routine histology) from 736 patients (participants in Trial V of the International [Ludwig] Breast Cancer Study) were examined by serial sectioning and staining with haematoxylin and eosin (two sections from each of six levels) and by immunohistochemistry of a single section (with two anticytokeratins AE-1 and CAM 5.2). After median follow-up of 12 years, disease-free and overall survival were estimated by Kaplan-Meier methods. Findings. Occult nodal metastases were detected by serial sectioning and haematoxylin and eosin in 52 (7%) of 736 patients and by immunohistochemistry in 148 (20%). Only two (3%) of 64 invasive lobular or mixed invasive lobular and ductal cancers had node micrometastases, detected by haematoxylin and eosin, compared with 25 (39%) by immunohistochemistry. Occult metastases, detected by either method, were associated with significantly poor disease-free and overall survival in postmenopausal but not in premenopausal patients. Immunohistochemically detected occult lymph-node metastases remained an independent and highly significant predictor of recurrence even after control for tumour grade, tumour size, oestrogen-receptor status, vascular invasion, and treatment assignment (hazard ratio 1.79 [95% CI 1.17-2.74], p = 0 007). Interpretation. The immunohistochemical examination of ipsilateral axillary lymph nodes is a reliable, prognostically valuable, and simple method for the detection of occult nodal metastases. Immunohistochemistry is recommended as a standard method of node examination in postmenopausal patients.

AB - Background. This study was designed to ascertain whether immunohistochemical methods could improve the detection of metastases in primary breast-cancer patients whose axillary lymph nodes were classified, by conventional methods, as disease free. Methods. Ipsilateral lymph nodes (negative for metastases by routine histology) from 736 patients (participants in Trial V of the International [Ludwig] Breast Cancer Study) were examined by serial sectioning and staining with haematoxylin and eosin (two sections from each of six levels) and by immunohistochemistry of a single section (with two anticytokeratins AE-1 and CAM 5.2). After median follow-up of 12 years, disease-free and overall survival were estimated by Kaplan-Meier methods. Findings. Occult nodal metastases were detected by serial sectioning and haematoxylin and eosin in 52 (7%) of 736 patients and by immunohistochemistry in 148 (20%). Only two (3%) of 64 invasive lobular or mixed invasive lobular and ductal cancers had node micrometastases, detected by haematoxylin and eosin, compared with 25 (39%) by immunohistochemistry. Occult metastases, detected by either method, were associated with significantly poor disease-free and overall survival in postmenopausal but not in premenopausal patients. Immunohistochemically detected occult lymph-node metastases remained an independent and highly significant predictor of recurrence even after control for tumour grade, tumour size, oestrogen-receptor status, vascular invasion, and treatment assignment (hazard ratio 1.79 [95% CI 1.17-2.74], p = 0 007). Interpretation. The immunohistochemical examination of ipsilateral axillary lymph nodes is a reliable, prognostically valuable, and simple method for the detection of occult nodal metastases. Immunohistochemistry is recommended as a standard method of node examination in postmenopausal patients.

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