Interview
with Neil Love, MD from Breast Cancer Update for Surgeons,
Program 2000
Play
Audio Below:
There are two ways to find small metastasis in a node: Either by
multiple cut serial sections or by enhanced staining procedures,
immunohistochemistry. And so we know since 1948 that if you cut
through in serial sections you’re going to upstage anywhere
from 15 to 30%. So it’s really nothing new, the numbers have
not changed since before I was born. So what’s happened is
we just never documented, in sufficient ways, levels in a perspective
study whether this is meaningful for survival. So for this study
we will have enough patients to demonstrate if there is a survival
difference, we’ll be able to demonstrate that. So, since we
know that the most important is in the 1 to 2 millimeter range,
as a cut-off that these are definitively shown to be pathologically
meaningful, we’re doing serial sections at the participating
site. The pathologist will cut the node in layers. That will be
used clinically. But then, those nodes are negative with that initial
serial section analysis, with H&E, will then be sent to University
of Vermont in a blinded fashion and have immunohistochemistry performed.
And
we think the conversion rate’s probably going to be around
10%.
