Biological behaviour and clinical implications of micrometastases

Background The most important prognostic determinant in cancer is the identification of disseminated tumour burden (metastases). Micrometastases are microscopic (smaller than 2 mm) deposits of malignant cells that are segregated spatially from the primary tumour and depend on neovascular formation (...

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Bibliographic Details
Published in:British journal of surgery 2000-12, Vol.87 (12), p.1629-1639
Main Authors: Kell, M. R., Winter, D. C., O'Sullivan, G. C., Shanahan, F., Redmond, H. P.
Format: Article
Language:English
Subjects:
Biological and medical sciences
Biopsy, Needle - methods
Bone Marrow Neoplasms - diagnosis
Breast Neoplasms - diagnosis
Carcinogenesis, carcinogens and anticarcinogens
Colorectal Neoplasms - diagnosis
Enzyme-Linked Immunosorbent Assay - methods
Flow Cytometry
General aspects
Head and Neck Neoplasms - diagnosis
Humans
Immunohistochemistry - methods
Lymphatic Metastasis - diagnosis
Medical sciences
Melanoma - diagnosis
Melanoma - secondary
Neoplasm Metastasis - diagnosis
Neoplastic Cells, Circulating
Neovascularization, Pathologic - physiopathology
Stomach Neoplasms - diagnosis
Tumors
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Summary:Background The most important prognostic determinant in cancer is the identification of disseminated tumour burden (metastases). Micrometastases are microscopic (smaller than 2 mm) deposits of malignant cells that are segregated spatially from the primary tumour and depend on neovascular formation (angiogenesis) to propagate. Methods The electronic literature (1966 to present) on micrometastases and their implications in malignant melanoma and epithelial cancers was reviewed. Results Immunohistochemical techniques combined with serial sectioning offer the best accuracy for detection of nodal micrometastases. Molecular techniques should be reserved for blood samples or bone marrow aspirates. Detection of micrometastases in regional lymph nodes and/or bone marrow confers a poor prognosis in epithelial cancers. The concept of sentinel node biopsy combined with serial sectioning and dedicated screening for micrometastases may improve staging procedures. Strategies against angiogenesis may provide novel therapies to induce and maintain micrometastatic dormancy. Conclusion The concept of micrometastases has resulted in a paradigm shift in the staging of epithelial tumours and our overall understanding of malignant processes. © 2000 British Journal of Surgery Society Ltd
ISSN:0007-1323
1365-2168
DOI:10.1046/j.1365-2168.2000.01606.x