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Donald N. Reed, Jr, MD; Jon Johnson, MD; Philip Richard, PhD; Stanley McCormick, MD; Nancy Shannon, MD, PhD; Raouf A. Mikhail, MD; Janet Osuch, MD; Patricia B. Cerrito, PhD; Kelly M. McMasters, MD, PhD

Arch Surg. 2000;135:1422-1426.

Background  A small proportion of T1 or T2 node-negative breast cancer tumors will recur in patients by 5 years, and more by 10 years. Results of recent studies have suggested improvement in overall survival with administration of adjuvant chemotherapy to all patients. More sensitive and specific methods are needed to identify patients at highest risk for recurrence who might benefit most from adjuvant therapy, saving others from unnecessary treatment. Some investigators have suggested DNA flow cytometry as a method to discriminate patients at greatest risk for recurrence.

Hypothesis  DNA flow cytometry has predictive value for breast cancer recurrence in node-negative patients.

Methods  The cancer registry of a medium-sized university-affiliated hospital was used to identify patients with T1-2 N0 M0 breast cancer treated with a uniform surgical approach and no adjuvant therapy who had completed at least 5 years of follow-up or had recurrence. Flow cytometric analysis was performed on paraffin-embedded specimens.

Results  Of 115 patients, 92 (80%) had disease-free survival without recurrence and 23 (20%) had recurrence. Comparison of diploid and nondiploid tumors for likelihood of recurrence revealed no association (P = .79). Furthermore, the DNA index and S-phase fraction were not significantly different between recurrent and nonrecurrent groups.

Conclusions  The likelihood of recurrence of small node-negative breast cancers after mastectomy cannot be accurately predicted on the basis of DNA flow cytometric analysis. Traditional methods for determining risks—such as nuclear and histological grade, lymph node status, and tumor size—seem to be more useful. Sentinel lymph node biopsy techniques may increase the detection of micrometastases.

From the Department of Surgery, Michigan State University College of Human Medicine (Drs Reed, Johnson, Mikhail, and Osuch), the Departments of Surgery (Drs Reed and Mikhail) and Medical Research (Dr Shannon), McLaren Regional Medical Center, and the Department of Mathematics and Statistics, Kettering University (Dr Richard), Flint; the Department of Pathology, United Hospital, St Paul, Minn (Dr McCormick); and the Departments of Mathematics (Dr Cerrito) and Surgery (Drs Reed and McMasters), University of Louisville, Louisville, Ky.

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