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J Thorac Cardiovasc Surg 2003;126:332-333
© 2003 The American Association for Thoracic Surgery

Editorial

Occult metastases: real harm or false alarm?

Richard J. Cote, MD, FRCPatha,*

a the University of Southern California/Keck School of Medicine, Norris Comprehensive Cancer Center, Los Angeles, Calif., USA

Received for publication October 24, 2002; accepted for publication November 5, 2002.

* Address for reprints: Richard J. Cote, MD, FRCPath, USC Norris Comprehensive Cancer Center, Department of Pathology, Room 2424, 1441 Eastlake Ave, Los Angeles, CA 90033, USA
cote_r@norris.hsc.usc.edu

The first 20% of the full text of this article appears below.

The most important factor predicting the outcome for patients with lung cancer (and indeed most solid tumors) is whether the tumor has spread locally, regionally, and/or systemically. It is well recognized that occult spread of tumor can occur, even in patients who have undergone complete removal of the primary tumor, and this phenomenon is the basis for the later development of overt metastases in these patients. Indeed, the possible presence of occult tumor dissemination is the rationale behind the use of systemic adjuvant chemotherapy in patients who have undergone definitive treatment of the primary tumor. Recognizing this, substantial efforts have been made to devise sensitive methods to detect occult regional and systemic spread of tumor. The central idea is that the detection of occult tumor might identify those patients at increased risk for recurrence and might thus affect the subsequent management of these patients, including the decision to administer adjuvant systemic therapy.

The article by Marchevsky and colleagues1 comes from a group long involved in the study and analysis of lung cancer and represents a substantial undertaking. The goal of this study was to determine the incidence and significance of finding previously undetected lymph node metastases (termed here "occult lymph node metastases") in patients with non–small cell lung carcinoma by using sensitive immunohistochemical procedures. The investigators examined a range of patients with non–small cell lung . . . [Full Text of this Article]






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