Detecting Occult Lymph Node Metastases Has Little Benefit

WEDNESDAY, Jan. 19 (HealthDay News) -- Occult metastases are prognostic variables in patients with breast cancer who have negative sentinel lymph node biopsies, but the difference in five-year outcome is very small, according to a study published online Jan. 19 in the New England Journal of Medicine.

Donald L. Weaver, M.D., from the University of Vermont College of Medicine in Burlington, and colleagues randomized 3,887 women with breast cancer to sentinel-lymph-node biopsy plus axillary dissection or biopsy alone. Biopsies of pathologically negative sentinel lymph nodes were further analyzed to detect all macrometastases larger than 2 mm.

The researchers identified occult metastases in 15.9 percent of the patients. Analysis indicated a significant difference between patients in whom occult metastases were detected and those in whom they were not detected with respect to overall survival, disease-free survival, and distant disease-free interval. The adjusted hazard ratios were 1.4 for death, 1.3 for any outcome event, and 1.3 for distant disease. Kaplan-Meier five-year overall survival estimates were 94.6 percent in those with occult metastases and 95.8 percent in patients without occult metastases.

"These data do not indicate a clinical benefit of additional evaluation, including immunohistochemical analysis, of initially negative sentinel nodes in patients with breast cancer," the authors write.

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