Biopsy I had a sentinel node biopsy and the pathology report indicated that I have micrometastasis. Does this mean I need chemotherapy? Should I get a second opinion? Diagnosing micrometastasis can be very difficult. This is because the pathologist needs to determine if what is being looked at are cells that were displaced during surgery or an actual spread of cancer cells. We have become increasingly aware that displacement during a sentinel node procedure or an axillary node procedure occurs more often than we thought. This displacement of cells is not the same as having metastasis and it does not require the treatment with chemotherapy that you would need if it an actual metastasis had occurred.
If only one or several clumps of cells of breast cancer are found in a lymph node based on IHC staining only or RT-PCR only, and they measure less than .2 mm, they are considered isolated tumor cells and the nodes are still considered negative (pN(i+). That's because these are thought to be cells that were dislodged during the sentinel node procedure and not cells that made it to the nodes on their own.) Cancer deposits greater than 0.2 millimeters but less than 2 millimeters are considered micrometastasis and are termed pN1mi, while any that are bigger than 2 millimeters are considered pN1.
Only an expert in breast pathology can look at the cells and determine if it is truly micrometastasis or if it is cell displacement. Your next step should be to get a second pathology opinion. This second opinion should not come from a general pathologist but from a specialist in breast pathology. There are many excellent breast pathologists throughout the country who can provide a second opinion. To get a second pathology opinion, you will need to have the hospital where you had your surgery performed send your slides to the pathologist you have selected.
You may also want to consider being seen at a multidisciplinary breast care center where you could not only bring your pathology slides and breast films for review, but be seen by a breast specialist, medical oncologist, and radiation oncologist. They would review your pathology slides and mammography images and then discuss as a group how they think you should proceed. To find this type of program in your area, contact the university-based hospital nearest you, the American Cancer Society, a local breast cancer support group, or one of the 60 NCI Comprehensive Cancer Centers.
If there are indeed multiple areas of micrometastases, doctors would typically recommend chemotherapy because there would be concern that an invasion had been missed.
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