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Dr. Rosser has hypothesized in one article1 (and many letters) that sentinel lymph node micrometastases are of traumatic origin. He points out our error in attributing to him the claim that these “traumets” lack clinical significance, and we stand corrected. However, our goal was not to address the important question of prognostic significance (which is already the subject of the multicenter ACOSOG Z00102 and NSABP B-323 trials), but to address his concerns directly: is the frequency of SLN micrometastases related to the degree of preoperative tumor manipulation independent of other known predictors? Our study suggests, with qualifications, that to some degree it is.4

We do not agree with his assertion that “traumets are the root cause of truemets,” or with his statements1 1) that breast carcinoma screening activities (clinical examination and mammography) cause micrometastases; 2) that survival of T1a breast carcinoma was superior in the prescreening era of one-step, modified radical mastectomy; 3) that lymph node micrometastases are observed primarily in organs that can be “squeezed,”; 4) that “squeezing” explains breast carcinoma multifocality and local recurrence after breast conservation; and 5) that the above factors will collectively overshadow current improvements in the diagnosis and treatment of this disease. These concepts fly in the face of an overwhelming body of data, and what he describes as a “clarion call of caution,” we find to be anything but clear. Looking to the future, the profound mystery of tumor invasion and metastasis will require a biologic explanation, not a mechanistic one.

Hiram S. Cody III M.D.*, * The Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.

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