Breast cancer patients with micrometastases only: Is a basis provided for tailored treatment?

Women with breast cancer and micrometastases only constitute a treatment dilemma. If only a micrometastasis is found in a sentinel. lymph node, an axillary lymph node dissection may be considered to be overtreatment and perhaps could be avoided. However, studies have shown decreased survival in patients with micrometastases only. This paper focuses on the pathological work-up behind the classification of breast cancer patients having micrometastases only and on the most recent literature concerning prognosis for breast cancer patients with micrometastases. The goal was to determine if studies to date have been able to define a population of breast cancer patients with micrometastases where the size of the metastasis could indicate whether an axillary lymph node dissection should be undertaken. Tailored surgical treatment of breast cancer patients with micrometastases only is not possible at the present time, due to tack of standardization in the pathological work-up of lymph nodes, which implies that this group of breast cancer patients cannot be delimited with sufficient precision. Tailored systemic therapy is also impossible due to tack of a precisely defined target for a feasible therapy. (C) 2008 Elsevier Ltd. All rights reserved.