The clinical significance of axillary lymph node micrometastases in breast cancer

Objective. To evaluate the clinical significancer of axillary lymph-node micrometastases, in the era of sentinel lymph node (SLN) biopsy. Data sources. Searches of MEDLINE (1966-2003) and an extensive manual review of journals were performed using the key search terms breast cancer, axillary lymphnode micrometastases, micrometastatic disease, and SLN biopsy. Study selection. All articles identified from the data sources were evaluated and all information deemed relevant was included for this review. Conclusions. Axillary lymphnode micrometastases can be detected by serial sectioning, immunohistochemistry, or reverse transcriptase-polymerase chain reaction (RT-PCR). The presence of axillary SLN micrometastases is generally associated with a worse prognosis and is an indication for axillary lymph node dissection (ALND) and adjuvant therapy. The clinical significance of micrometastases identified by RT-PCR remains unknown and further research with longer follow-up is needed to ascertain the clinical implications of a positive result. (C) 2004 Elsevier Ltd. All rights reserved.