Effect of Occult Metastases on Survival in Node-Negative Breast Cancer

The authors detected isolated tumor-cell clusters in otherwise negative nodes in 16% of women with breast cancer. The 5-year estimates of survival were 94.6% among women with occult nodal spread and 95.8% among those without occult nodal spread. A landmark 1948 article by Saph and Amromin showed that the routine analysis of lymph nodes in breast cancer was insufficient to detect all metastases present. 1 Although the practice of additional pathological analysis was not adopted, the concept of occult metastases (metastases that are not detected initially but are detected with further evaluation) was introduced and has been the subject of considerable research and controversy over the ensuing decades. 2 – 4 The National Surgical Adjuvant Breast and Bowel Project (NSABP) trial B-32 was designed to evaluate whether sentinel-lymph-node biopsy alone was equivalent to complete axillary dissection with respect to overall survival . . .