MISSED NODAL METASTASES IN BREAST-CANCER

The routine use of immunohistochemistry has been suggested in the exam ination of the axillary nodes from patients with node-negative breast cancer in order to detect possible micrometastases. In this study, com prising 70 axillary specimens, we found missed micrometastases in 5 ly mph nodes from a total of 40 cases following staining with epithelial membrane antigen. These metastases were also visible in the original h aematoxylin and eosin stained slides, but missed on first examination. This makes a total of 10% of the cases, but only 0.8% of the nodes ex amined. Due to the increased expense of immunohistochemistry we would not recommend it as a routine in the examination of the axillary speci mens. Until the prognostic significance of such deposits has been clea rly defined we recommend hilar sectioning of the nodes, i.e. targeting of the sites of choice for micrometastases, and a second look at the slides from 'node-negative' cases, before they are reported.