López C, Bosch R, Orero G, et al. - Researchers sought to evaluated if patterns of immune cells in the primary tumor and in the axillary lymph nodes without metastasis (ALN−) differed between patients diagnosed without ALN+ (diagnosed-ALN−) and with ALN+ (diagnosed-ALN+) and the implications for clinical outcome. They included 11 immune markers applying immunohistochemistry, tissue microarray, and digital image analysis in 141 breast cancer (BC) individual samples (75 diagnosed-ALN+ and 66 diagnosed-ALN−). They determined two logistic regression models to distinguish the clinical, pathologic, and immunologic variables associated with the presence of ALN+ at diagnosis. At diagnosis, there are immune patterns in the ALN− correlated with the presence of ALN+. In these regression models, results revealed a small subgroup of diagnosed-ALN+ with ALN−. This small subgroup also displayed similar clinical behavior to that of the diagnosed-ALN−. The results imply that the immune response present in ALN− at diagnosis could influence the clinical outcome of BC individuals.