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[The value of immunohistochemistry in the analysis of axillary node dissection]
F Pellat Finet1, D Raudrant, M Guillaud
1Service de Gynécologie-Obstétrique A, Hôtel Dieu, Lyon.
Insights
Immuno-histochemistry (IHC) detects more lymph node metastases in breast cancer patients than Hemalum-Eosin-Safran (HES). IHC identified additional invasions and capsule breaches missed by HES, improving diagnostic accuracy.
Area of Science:
- Oncology
- Pathology
- Surgical Pathology
Background:
- Accurate staging of breast cancer relies on detecting axillary lymph node metastasis.
- Hemalum-Eosin-Safran (HES) is a standard method, but its sensitivity may be limited.
- Immuno-histochemistry (IHC) offers enhanced cellular and tissue analysis.
Purpose of the Study:
- To compare the diagnostic efficacy of IHC versus HES in identifying lymph node metastasis in breast cancer patients.
- To quantify the additional metastatic information provided by IHC over HES.
Main Methods:
- A comparative analysis was performed on 42 breast cancer patients undergoing axillary lymphatic clearance.
- Immuno-histochemistry (IHC) and Hemalum-Eosin-Safran (HES) staining were used to examine 365 lymph nodes.
- Results from both methods were systematically compared for detecting lymph node invasion and capsular breaches.
Main Results:
- HES was negative for metastasis in 32 patients, and IHC also found no metastasis in these cases.
- In 10 HES-positive patients, IHC identified 2 additional lymph node invasions and 1 capsular breach missed by HES.
- Literature review confirms IHC is not inferior to HES, with higher detection rates in infiltrating lobular carcinomas (7-33%) and canalicular carcinomas (0.9-11%).
Conclusions:
- Immuno-histochemistry (IHC) provides superior sensitivity for detecting lymph node metastasis in breast cancer compared to HES.
- IHC identifies additional micrometastases and capsular breaches, crucial for accurate staging and treatment planning.
- Despite a longer protocol, IHC's clearer results warrant its integration into standard practice for breast cancer lymph node analysis.
Abstract:
Immuno-histochemistry (IHC) was used and compared with Hemalum-Eosin-Safran (HES) in the analysis of the products of axillary lymphatic clearance in 42 women had breast cancer. In 32 patients who were negative by the HES test there was no lymph metastasis found by the IHC test in the 365 lymph nodes which were examined. In 3 out of 10 patients who were positive which the HES test 2 extra lymph node invasions were found, and one breach in the lymph node capsule that had not been diagnosed through HES testing were found. A review of the literature shows that the IHC test has never been show to be inferior to the HES test. The number of additional nodes that have been invaded varies between 0.9-11% in infiltrating canalicular carcinomas. The changes of the IHC test is greater in infiltrating lobular carcinomas. It varies between seven and 33%. Although the technique for using IHC is longer, it is easier to read the result and this method should be set up in current practice.
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