G. Farshid et al., Computer simulations of lymph node metastasis for optimizing the pathologic examination of sentinel lymph nodes in patients with breast carcinoma, CANCER, 89(12), 2000, pp. 2527-2537
BACKGROUND. Many empiric protocols are used to detect metastases in sentine
l lymph nodes (SLNs), but comparison of the efficacy of these methods is im
practical because tissue is lost in processing, making reassessment with an
other policy difficult. Consequently, performance indicators of this test a
re largely unknown.
DESIGN. The authors retrospectively examined 112 SLNs removed from 89 patie
nts with breast carcinoma treated at the authors' institution and used the
histologic data to devise a mathematic model of a SLN with Matlab modeling
software. The authors simulated examination of this computer-generated (vir
tual) lymph node according to several macroscopic and histologic sampling p
rotocols and for each protocol assessed the probability of detecting microm
etastases of specified sizes. The authors used published costing figures to
estimate the cost of the policies.
RESULTS. Direct comparison of 6 sectioning strategies currently in use by p
athology laboratories showed the chances of detecting a 500-mum metastasis
ranged from 20% to 75%. Four of the 6 protocols had a less than 30% chance
of detecting metastases of this size. The detection rate of smaller metasta
ses was poorer. Cost was not a good discriminator because some policies wer
e more efficient than others.
CONCLUSIONS. The detection of metastases is highly dependent on the methods
used to look for them. The authors' simulations suggest that commonly used
methods of examining lymph nodes have high false-negative rates, particula
rly for small metastases. There is an urgent need for pathologists and clin
icians to agree on the minimum size of SLN metastases that will be sought b
y histology and set standard methods for examining these lymph nodes. Cance
r 2000;89:2527-37. (C) 2000 American Cancer Society.