Microcopically postive nodes in breast cancer

Whether one should consider microscopic nodal disease to be positive or negative nodes is controversial. This is so because node positivity in past studies was assessed by visual examination and not IHC, leaving breast experts without significant data on this recently identified subtype. A pathologic classifications for these cases has been created: pN1: Metastasis in one to three axillary lymph nodes, and/or in internal mammary nodes with microscopic disease detected by SLN dissection but not clinically apparent. A recent clinical guideline states: "Immunochemical staining with cytokeratin or other techniques to identify "submicroscopic" metastasis is often used, but the results should not be used to influence clinical decisions with respect to adjuvant therapy." Tumor deposits of 0.2 mm or larger are usually considered positive but less than that is considered negative. This is called pN0(i+) - No regional lymph node metastasis histologically, positive IHC, no IHC cluster greater than 0.2 mm (AJCC Version 6).

P.T. Truong et al, Micrometastatic Node-positive Breast Cancer: An Analysis of Outcomes in Comparison to Node-negative and Macrometastatic Node-positive Disease
Clinical Oncology Volume 19, Issue 3, April 2007, Page S48 

Gordon F. Schwartz, Clinical Practice Guidelines for the Use of Axillary Sentinel Lymph Node Biopsy in Carcinoma of the Breast: Current UpdateThe Breast Journal Volume 10 Issue 2, Pages 85 - 88 Published Online: 10 Mar 2004

Impact and Outcomes of Routine Microstaging of Sentinel Lymph Nodes in Breast Cancer: Significance of the pN0(i+) and pN1mi Categories, Pugliese MS, Beatty JD, Tickman RJ, et al (Swedish Med Ctr, Seattle, WA; Swedish Cancer Inst, Seattle, WA; CellNetix Pathology, Seattle, WA; et al) Ann Surg Oncol 16:113-120, 2009§
D. Winchester Breast Diseases: A Year Book Quarterly, Volume 20, Issue 3, Pages 299-301

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Breast cancer is a cancer of breast tissue. Worldwide, it is the most common form of cancer in females, affecting approximately one out of nine to thirteen women who reach age ninety at some stage of their life in the Western world.