Benign mechanical transport of breast epithelial cells to sentinel lymph nodes

Nils M. Diaz, Charles E. Cox, Mark Ebert, John D. Clark, Vesna Vrcel, Nicholas Stowell, Anu Sharma, James W. Jakub, Alan Cantor, Barbara A. Centeno, Elisabeth Dupont, Carlos Muro-Cacho, Santo Nicosia

Research output: Contribution to journalArticlepeer-review

76 Scopus citations


The evaluation of sentinel lymph nodes (SLNs) for the presence of malignant epithelial cells is essential to the staging of breast cancer patients. Recently, increased attention has focused on the possibility that epithelial cells may reach SLNs by benign mechanical means, rather than by metastasis. The purpose of this study was to test the hypothesis that pre-SLN biopsy breast massage, which we currently use to facilitate the localization of SLNs, might represent a mode of benign mechanical transport. We studied 56 patients with invasive and/or in situ ductal carcinoma and axillary SLNs with only epithelial cells and/or cell clusters (≤0.2 mm in diameter and not associated with features of established metastases) detected predominantly in subcapsular sinuses of SLNs on hematoxylin and eosin- and/or anti-cytokeratin-stained sections. No patient had an SLN involved by either micro- or macro-metastatic carcinoma. Epithelial cells and cell clusters, ≤0.2 mm in size and without features of established metastases, occurred more frequently in the SLNs of patients who underwent pre-SLN biopsy breast massage (P < 0.001, χ2 test). The latter finding supports the hypothesis that pre-SLN biopsy breast massage is a mode of benign mechanical transport of epithelial cells to SLNs.

Original languageEnglish (US)
Pages (from-to)1641-1645
Number of pages5
JournalAmerican Journal of Surgical Pathology
Issue number12
StatePublished - Dec 2004


  • Benign mechanical transport
  • Breast cancer
  • Occult micrometastasis
  • Sentinel lymph node

ASJC Scopus subject areas

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine


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