The role of tiny axillary lymph nodes in breast cancer staging

Objective To evaluate the effect of tiny axillary lymph nodes in breast cancer staging. Methods Axillary specimens from 127 breast cancer patients were included. After excising the lymph nodes by palpation and visualization, the remaining axillary tissue was immersed into Carnoy's solution for 6-12 hours. Then the left axillary tissue was placed in the Pyrex tray and transilluminated from the below. The tiny lymph nodes were easily recognized as white chalky nodules standing out of the background with semitransparent fat. The lymph nodes were identified by pathologic examined. Results 2 483 lymph nodes were found by the traditional methods and 878 more lymph nodes were found by immersed into Carnoy's solution. Among them 781 lymph nodes were smaller than 3 mm. The average number of lymph nodes founded by the new way was 26.47 ±9.69 compared to 19.55 ±7.95 by the routine method. Four cases considered previously to be pNO became pN1, two cases previously graded as pN1 became pN2, and another case was upstaged from pN2 to pN3. Conclusions The new method is an easy and effective way for detecting tiny lymph nodes in axillary, and it helps to accurate staging and possibility change the method of therapy.