Jama Logo A report published few months back explored risks of bone fractures associated with breast cancer patients. Now, according to a study conducted by John Wayne Cancer Institute at Saint John’s Health Center, sentinel lymph node metastases identified during the diagnostic procedure of immunohistochemical staining was not apparently related to the cumulative survival rate among women with initial-stage breast cancer who were exposed to breast-conserving therapy.

Sentinel lymph node (SLN) dissection is a major breakthrough in the approach adopted for early stage breast cancer. This procedure seemingly allows minimally penetrative axillary staging and precise observation of the SLN. This also paves way to recognize micro metastases and individual tumor cells of unknown prominence. Immunochemical staining of SLNs and bone marrow seem to spot breast cancer metastases that are usually not visible in everyday pathological or clinical tests.

As part of the study, women with clinical T1 to T2N0M0 invasive breast carcinoma participated in the American College of Surgeons Oncology Group Z0010 tests at 126 places from May 1999 to May 2003. These 5,210 patients went through breast-conserving surgery and SLN dissection. Bone marrow aspiration during the time of the trial was apparently optional but was made obligatory by March 2001. Sentinel lymph node and bone marrow samples were delivered to a central laboratory for immunochemical staining. The outcomes were concealed to the operating physicians.

Of 5,119 SLN prototypes almost 98.3% and 76.3% were devoid of the tumor by hematoxylin-eosin staining. Of 3,326 SLN specimens observed by immunohistochemistry, nearly 10.5% were tumor-positive. Of 3,413 bone marrow samplings, just 3% showed the presence of tumor. The set of women were checked until April 21, 2010. At an average point of follow-up of 6.3 years, there were reportedly 435 deaths and 376 women faced recurrent problems.

“Five-year rates of overall survival for patients with immunohistochemistry-negative SLNs were 95.7 percent and for those with immunohistochemistry-positive SLNs were 95.1 percent. Corresponding 5-year rates of disease-free survival were 92.2 percent and 90.4 percent, respectively,” specified Armando E. Giuliano, M.D., formerly of the John Wayne Cancer Institute at Saint John’s Health Center, Santa Monica, Calif., (and now with Cedars-Sinai Medical Center, Los Angeles), and colleagues.

The analysts also showed that occult bone marrow metastases were supposedly linked to reduced overall survival just when clinicopathological variables were not taken into account. Bone marrow trails with immunocytochemistry may locate high-risk women. But the prevalence rates in the Z0010 trial were too less to suggest integrating bone marrow aspiration biopsy into regular condition for patients in the earliest phases of breast cancer.

The outcomes of Z0010 trial have essential comprehensions for clinical utilities. Information from Z0010 study reveals that occult metastases detected by immunohistochemistry are not related to differences of survival rate of women in the earliest stages of breast cancer. An extended follow-up analysis might unfold meager differences in results. However, these are not likely to be of any vitality to clinical utilities according to revelations of National Surgical Adjuvant Breast and Bowel Project B-32 trial. Regular immunohistochemical examination of hematoxylin-eosin negative SLNs and everyday immunocytochemical observation of bone marrow are not presumably guarded for clinical usage for early-stage

The study is published in the July 27 issue of JAMA.