Studies concerning the regional lymph node in cancer.VII. Thymidine uptake by cells from nodes of breast cancer patients relative to axillary location and histopathologic discriminants

Cells derived from 279 regional lymph nodes (RLNCs) of 62 women with primary breast cancer when evaluated immediately after removal were found to vary significantly relative to their uptake of tritiated thymidine (3HT). The variation was related to the position of nodes in the axilla. Uptake by cells from low axillary nodes was significantly greater than was that by cells from high lying nodes. Consideration is given to the possibility that the increased uptake by low RLNCs reflects the consequences of stimulation by tumor antigen. Relation of the findings to histopathologic discriminants present in nodes and tumors revealed: (a) that the presence of sinus histiocytosis was unrelated to either location of nodes in the axilla or to 3HT uptake by RLNCs, confirming our previous observations indicating no functional or other relationship for that parameter; (b) that while a significantly greater proportion of low than high nodes contained lymph follicles, no correlation existed between 3HT uptake and the presence or absence of follicles in low nodes; and (c) that in general, no relationship existed between nuclear grade or lymphocytic infiltration of tumor and 3HT uptake by RLNCs. The present findings and those reported by others suggest that high axillary nodes in breast cancer patients are more closely related functionally to distant than to low axillary nodes and that despite their anatomical location, they might best be considered biologically and relative to their surgical management in the same category as supraclavicular, cervical, or contralateral axillary nodes. Also, in view of the present findings, the wisdom of removing low axillary nodes in breast cancer operations may be challenged.