Department of Pathology, Helsinki University Central Hospital, and University of Helsinki, Haartman Institute, Helsinki, Finland.
Hum Pathol. 2012 Nov;43(11):1940-7. doi: 10.1016/j.humpath.2012.01.022. Epub 2012 May 9.
We reviewed lymph node samples from 473 consecutive breast cancer cases with either negative sentinel nodes or isolated tumor cells to evaluate the rate of false-positive sentinel node findings. Nuclear morphometry was applied to compare nuclear atypia between the primary tumor and metastases classified as isolated tumor cells by size. In addition, the role of the diagnostic preoperative biopsy method, either core needle biopsy or fine needle aspiration cytology, on the prevalence of isolated tumor cells was investigated. In addition, we studied the expression of metastasis-associated protein 1 in the primary tumor and corresponding metastases in 95 cases, including 52 isolated tumor cell cases, to distinguish a true metastasis from a benign epithelial displacement. Our review revealed 4 false positives and 7 false negatives from 473 sentinel node cases. In addition, 5 true-positive cases were upstaged from isolated tumor cells to micrometastases. No association was found between the preoperative biopsy method and the sentinel node status (P=.859). There was no difference in nuclear atypia, when the cells in isolated tumor cells and primary tumor were compared. Therefore, small metastases do not represent benign epithelial displacement. Isolated tumor cell findings did not correlate with preoperative biopsy methods. The metastasis-associated protein 1 staining score sum was lower in the metastases than in the primary tumor in 72% of cases, including all sizes of metastases. These data suggest that metastasis-associated protein 1 staining is not ideal for investigating the possible malignant nature of smaller metastases because of the relatively low concordance between the primary tumor and metastases, even macrometastases.
我们回顾了 473 例连续乳腺癌病例的淋巴结样本，这些病例要么是阴性的前哨淋巴结，要么是孤立的肿瘤细胞，以评估假阳性前哨淋巴结发现的比率。核形态计量学被应用于比较原发肿瘤和大小分类为孤立肿瘤细胞的转移灶之间的核异型性。此外，还研究了术前诊断活检方法（核心针活检或细针穿刺细胞学）对孤立肿瘤细胞发生率的影响。此外，我们研究了 95 例包括 52 例孤立肿瘤细胞病例的原发肿瘤和相应转移灶中转移相关蛋白 1 的表达，以区分真正的转移灶和良性上皮移位。我们的回顾显示，在 473 例前哨淋巴结病例中，有 4 例假阳性和 7 例假阴性。此外，5 例真阳性病例从孤立肿瘤细胞升级为微转移。术前活检方法与前哨淋巴结状态之间没有相关性（P=.859）。当比较孤立肿瘤细胞和原发肿瘤中的细胞时，没有发现核异型性的差异。因此，小转移灶并不代表良性上皮移位。孤立肿瘤细胞的发现与术前活检方法无关。转移相关蛋白 1 染色评分总和在转移灶中比在原发肿瘤中低 72%，包括所有大小的转移灶。这些数据表明，转移相关蛋白 1 染色并不理想，因为即使是大转移灶，原发肿瘤和转移灶之间的一致性也相对较低，因此无法调查较小转移灶的可能恶性性质。
