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The influence of occult metastases on breast cancer survival is unclear. In the American College of Surgeons Oncology Group Z0010 trial, researchers sought to determine the prevalence and clinical significance of occult nodal metastasis identified with immunostaining of sentinel lymph nodes (SLNs), bone marrow aspirates, or both in 5210 eligible women with early-stage breast cancer (node-negative T1 or T2) who underwent breast-conservation therapy with adjuvant whole-breast irradiation. SLN specimens from 5119 patients were examined; 3904 (76.3%) were negative by hematoxylin-eosin staining. Of these, 3326 were assessed with immunohistochemistry (IHC); 349 (10.5%) had occult metastasis identified by IHC alone. In all, 3413 patients underwent…