STAGING NODAL GROWTH IN BREAST-CANCER ON A HISTOLOGICAL BASIS

This study describes the axillary tumour-load in 484 women with breast carcinoma with spread to one or more nodes. The aim was to relate tum our-lend to nodal histology. The tumour area and that of residual lymp hoid tissue was measured from standardised nodal sections. The presenc e / absence of tumor cells in the efferent vessels (EV) defined their nodal status as EV+ or EV-. The former has a poor prognosis. While the number of EV+ cases increased with the total tumour-load, the number of EV- cases decreased. In the EV+ there was high positive correlation between tumour-load and number of deaths from breast cancer, with a c orresponding negative correlation in the EV-. Twice as many patients w ith EV+ nodes died of boast cancer compared to the EV- group. Investig ation of 164 consecutive tumour-bearing nodes showed a similar pattern . Irrespective of EV status the area of residual lymphoid tissue remai ned constant. Although the lymphoid area was similar the tumour-load w as twice as high in the EV+ cases. These findings stress basic biologi cal differences in the growth of breast carcinoma in the nodes. Patien ts with the smallest micrometastases that are found in the afferent ly mphatics of the node and the EV+ patients in which tumour cells are pr esent in the efferent nodal vessels have a poor short-term prognosis. The patients with larger micrometastases in the nodal lymphoid tissue and also EV- patients with the next highest tumour-load are both of lo w prognostic risk, with the exception of the few EV- with an exception ally high tumour-load.