| IntrductionThe epidemiology has demonstrated that about 80% patients with breast cancer died of systemic metastases. So it is vital important for the patients with breast cancer to evaluate the risk of recurrence and metastases after surgical therapy. It is unnecessary to treat all patients with adjuvant chemotherapy. Nowadays , many high risk factors of clinic, pathology and molecular biology have been found to predict the relapse and metastases of breast cancer. It is obviously partial to evaluate the situation of patients with breast cancer by using these factors. The situation of a current therapeutic dilemma is that the axillary lymph node(ALN) negative patients have 20% ~ 30% relapse rate within five years meanwhile the 40% ALN positive patients have overall survival of more than ten years. There is significant correlation between micrometastases and relapse and metastases. In late years, relevant and prognostic effect of micrometastases have been further studied and got valuable results. However, there is dispute on the correlation between micrometastases and the factors which influence prognosis of breast cancer, metastases and survival rate. Therefore, we detected micrometa-ses of bone marrow ( BM) and sentinel lymph node ( SLN) by using Flow Cy-tometry ( FCM) and investigated the clinical relevant. Besides, we used meta -analysis to estimate the effect of BM micrometastases on distant metastases in breast cancer before our study.Halsted performed the first standard radical mastectomy in 1984, since then the surgery has experienced multiple periods, such as extended radical mastectomy, modified radical mastectomy and conservative surgery. With the development of biology and evidence based medicine, surgery tends to conservation. But the routine axillary dissection is an indispensably part in any type of surger-y. The aim of axillary dissection is reducing the local recurrence, staging, pre-dieting the prognosis and instructing the adjuvant therapy. The complication, such as arm edema and dysfunction, will decrease the patients' quality of life. Modern biology theories consider that axillary dissection may have less effect on survival on part of patients with breast cancer. The necessity of axillary dissection for early breast cancer is doubted. Some patients will avoid the axillary dissection instead of sentinel lymph node biopsy ( SLNB). So, the SLN were detected by using blue dye in order to (1) Study the factors that affect detection rate and false negative rate of SLNB in breast cancer. (2) Detect the micrometastases in successfully identified negative ALN by using inmmunohistochemistry (IHC) assay and evaluate the relevant between some clinical and pathological factors with micrometastases in ALN. (3 ) Estimate the prediction value of SLN micrometastases on ALN micrometastases.Materials and Methods1. The clinical trials published on BM micrometastases in operable breast cancer were identified through Medline database. The results were pooled using meta - analysis to estimate the effect of BM micrometastases on distant metasta-ses in breast cancer.2. We performed SLNB in operable breast cancer by using methylthionium blue dye to study the factors that affect detection rate and false negative rate and the predicting value of SLN on ALN.3. We determined the micrometastases in successfully identified negative ALN by using IHC assay and evaluated the relevant between some clinical and pathological factors with micrometastases in ALN and the prediction value of SLN micrometastases on ALN micrometastases.4. Micrometastases in BM and SLN in patients with breast cancer were detected by FCM and IHC assay to investigate the clinical relevant of BM and SLN micrometastases.Results1. 63 papers, which were about the effect of BM micrometastases on distant matastases in breast cancer, were searched in Medline database, but only 9 ofthem met our inclusion criteria. The distant metastases rates in positive and negative BM micrometastases arm were 21% -91% and 7% -39% , respectively. The...
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