Two-thirds of our patients presented with a locally advanced breast cancer (stage 2a 3c) with disease in both the breast and axilla, with a high risk of systemic micrometastatic disease
. Almost all these patients require multimodality therapy, with chemotherapy, surgery and radiation all indicated.
In mastectomy patients, ALND can be avoided if there is a micrometastatic disease
and in macrometastatic patients with 1-2 positive lymph nodes with in favor of axillary RT when there is an indication for post-mastectomy RT.
The mechanism behind this benefit remains unclear but may result from inhibiting progression of metastatic disease, preventing additional metastatic seeding, or through an immunostimulatory abscopal effect on micrometastatic disease
with local T cell response can explain our findings as well.
, who see metastases at the time of implantation as a contraindication, but it must be taken into account that only 10-20% of patients have macroscopic evidence of metastatic disease, whereas 80-90% of patients with osteosarcoma are assumed to have micrometastatic disease
at initial diagnosis .
Therefore, it is important to treat micrometastatic disease
with perioperative chemotherapy.
One third of remaining 50% with organ confined disease actually have micrometastatic disease
at time of surgery.3
Patients with Stage II and III BC have a high risk of micrometastatic disease
. Therefore, prompt administration of adjuvant chemotherapy and endocrine treatments can be critical to OS.
Detection of micrometastatic disease
and monitoring of perioperative tumor cell dissemination in primary operable breast cancer patients using real-time quantitative reverse transcription-PCR.
(63) A declining rate of completion ALND for patients with micrometastatic disease
was documented nationwide by analysis of 1998-2005 data collected in the National Cancer Data Base.
A further 9 patients (4.2%) had metastatic deposits detected by IHC, of whom 4 (2.0% of total, 44.4% of those detected by IHC) had micrometastatic disease
, ranging from 0.2 mm to 1.0 mm in size.
Identification of a serum-detectable metabolomic fingerprint potentially correlated with the presence of micrometastatic disease
in early breast cancer patients at varying risks of disease relapse by traditional prognostic methods.