The most common site of dissemination of breast cancer is to the bony skeleton via the bone marrow and conventional diagnostic modalities including bone scanning, skeletal radiography and alkaline phosphatase at the time of initial treatment
fail
to
identify those patients who are going to relapse. There have been many reports that an occult micrometastasis could be detected in the bone marrow of breast cancer patients using a epithelial specific monoclonal antibodies in an indirect
immunofluorescent assay. Using a monoclonal antibody(AE1/AE3) against cytokeratin, occult tumor cells in the bone marrow of breast cancer patients(n=47) were identified at the time of surgery. The aim of the present study was to evaluate the
significance of the presence of tumor cells in the bone marrow of patients with primary breast cancer in relation to other prognostic factors. Of the 47 patient who entered the study between July 1991 and June 1992, 14(29.8%) were found to have
tumor
cells in their bone marrow. No significant differences in the percentage of patients with antigen positive cells were recorded between the node positive(33.3%) and node negative(27.6%) groups. Fourteen percent of T1, 30.8% of T2 and 57.1% of T3
displayed positive bone marrow results. Significant correlations were found between tumor cell detection and tumor size. According to the stage, 18.2% of patient with stage I, 30% of patients with stage II, 40% of patient with stage III, and 100%
of
patient with stage IV had extrinsic cells, but these trends did not reach the level of the statistical significance in this small number of patients. A relationship was found between the presence of micrometastasis and peritumoral lymphatic
invasion but
not peritumoral vascular invasion within the primary tumor, histological grade, nuclear grade, mitotic index and menopausal status were not related with presence of micrometastasis. During the medium duration of 1 year follow up, 3 of 13 patients
with
micrometastasis recurred at distant site, while one of 33 without micrometastasis showed a recurrence at ipsilateral axillary lymph node. These results suggest that detection of occult micrometastasis provides one of the significant predictors of
relapse and prognosis and guideline for the intensive adjuvant chemotherapy especially for the node negative patients.
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