Quantitative morphologic assessment of immunoreactivity in regional lymph nodes of patients with carcinoma of the breast.

The main quantitative problem in the pathologic evaluation of carcinoma of the breast is how to appraise host resistance. To study this in 107 patients with radically excised carcinoma of the breast, the axillary lymph nodes were weighed, the average sinus histiocytosis was estimated, and the plasma cells in the medullary cords were counted and expressed as a plasma cell index. The product of the lymphoid weight, the average sinus histiocytosis and the plasma cell index multiplied by 0.1 is called the hyperplasia index, which expresses quantitatively the cell mediated immunity and the humoral immunity in the axillary lymph nodes. The hyperplasia index was correlated with the metastatic tumor weight in the primary tumor with blood vessel invasion, lymphoid infiltration and volume of the tumor. There was a significant inverse relationship, p smaller than 0.001, between the hyperplasia index and the ratio of metastatic tumor weight to lymphoid weight. A significant direct relationship was found in the women with blood vessel invasion and low hyperplasia index values with increased metastatic tumor weight ratio to lymphoid weight, p smaller than 0.01. In patients without metastatic lymph nodes, there was a direct relationship between high hyperplasia indexes and lymphoid infiltration of the frank tumor, p smaller than 0.05. The hyperplasia index is considered a quantitative morphologic evaluation of the regional host defense reaction in the axillary lymph nodes, reflecting the antigenic strength of the tumor and the immune response to it.