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- Title
Isolated tumour cells in sentinel lymph nodes for primary breast cancer: A cohort analysis.
- Authors
Karkada, Manolhas A.; DeCoste, Ryan C.; Barnes, Penny J.; Rayson, Daniel; Bethune, Gillian C.
- Abstract
Introduction and Objective: Sentinel lymph node biopsy (SLNB) is a key component of breast cancer staging. Historically, many institutions performed cytokeratin immunohistochemistry (CK-IHC) on every SLNB to help detect isolated tumour cells (ITCs). This practice was discontinued at our institution in 2013 after guidelines suggested limited clinical utility. We aimed to determine the resultant impact on the rate of ITC detection. Methods: Upon Research Ethics Board approval, pathology reports were reviewed from 250 consecutive invasive breast cancer cases with SLNBs resected in 2010 and 2015. Data abstracted included: tumour type, CK-IHCs ordered, nodal status and presence of ITCs. Cases with ITCs in 2015 were re-reviewed by a breast pathologist. Data were analyzed using Fisher's exact test. Data and Results: In 2010, all cases utilized CK-IHC vs. 57 cases in 2015 (P<0.001). There were 22 cases with ITCs in 2010 vs. 11 in 2015 (P=0.07). 20 cases contained ITCs without additional metastases in 2010 vs. 9 in 2015 (P=0.054). Excluding lobular carcinomas, for which CKIHC is ordered reflexively at our institution, there were 18 cases with ITCs in 2010 vs. 7 in 2015 (P=0.038). In 2015, CK-IHC was ordered in 10 of 11 cases containing ITCs: 4 were lobular carcinomas, 3 had lymphovascular invasion, and 3 had CK-IHCs ordered to confirm an H&E suspicion of ITCs. Conclusion: Excluding lobular histology, a significant decrease in the reported ITC rate is observed since discontinuation of reflex CK-IHC testing. The cost impact and clinical significance of decreased ITC detection is being further investigated.
- Publication
Canadian Journal of Pathology, 2018, Vol 10, p22
- ISSN
1918-915X
- Publication type
Academic Journal