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Prognostic value of bone marrow biopsy in operable breast cancer patients at the time of initial diagnosis: Results of a 20-year median follow-up

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Abstract

From May 1975 until May 1980, 128 operable breast cancer patients, clinical stage I–II, had a core bone marrow biopsy (BMB) from the posterior iliac crest as a part of the routine diagnostic work-up at the time of initial diagnosis. The mean age of the patients was 56 years, range 26–93. In a previous study on this material, 10 patients (7.8 per cent) were positive for tumor cells and 118 negative by conventional histopathology of BMB [1]. In 1996 we reexamined all BMB separately at two laboratories, using monoclonal antibodies against cytokeratins AE1—AE3, KL1, CAM 5–2 (DOP), and DC10, BA17 (MCI). The number of extrinsic cells in the bone marrow was graded positive for micrometastases when ≥ 5 cells or suspicious when 1–4 cells per ∼2 × 106 bone marrow cells were found, using high power field magnification. Micrometastases were detected in 17 patients (13.3 per cent) and another 8 patients were classified as suspicious. The presence of micrometastases was correlated to the axillary lymph node stage and primary tumor location. Median follow-up was 20 years. All 17 micrometastatic patients relapsed and died within 6 years of disease progression with evident osseous metastases. There was one disease-free survivor of the 8 patients with suspicious BMB after 17 years of follow-up. The median overall survival was significantly shorter in tumor-cell positive patients, being 1.9 years compared to 11.7 years in the BMB negative and BMB suspicious groups (p < 0.0001). Immunohistochemical analysis of core BMB taken postoperatively may be useful in predicting the prognosis in patients with breast cancer clinical stage I–II.

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Authors and Affiliations

  1. Department of Oncology, Sahlgrenska University Hospital, Göteborg, Sweden

    K. Landys, R. Hultborn & E. Holmberg

  2. Department of Pathology (DOP), Sahlgrenska University Hospital, Göteborg, Sweden

    S. Persson

  3. Masaryk Memorial Cancer Institute (MCI), Brno, Czech Republic

    J. Kovařík

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  1. K. Landys
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  2. S. Persson
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  3. J. Kovařík
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  4. R. Hultborn
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  5. E. Holmberg
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Landys, K., Persson, S., Kovařík, J. et al. Prognostic value of bone marrow biopsy in operable breast cancer patients at the time of initial diagnosis: Results of a 20-year median follow-up. Breast Cancer Res Treat 49, 27–33 (1998). https://doi.org/10.1023/A:1005980919916

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