Figure 6 (IMAGE) Impact Journals LLC Caption Proposed mechanisms of tumor dissemination from primary breast tumors to metastases. CEACAM5-expression outlined as no expression (white circle), heterogeneous expression (half-filled grey circle) and homogeneous expression (filled grey circle) based on the observed expression patterns in a total of 59 sets of primary breast carcinomas (P) and corresponding lymph node metastases (M), including datasets from both cryosectioned tissue and TMA. The distribution of the 59 tumor sets are outlined along with a representative immunostain at the right, as well as the proportion of tumor-sets with the given profile. Hierarchy-locked suggests that the disseminating tumor cells remain in a specific differentiation state. Induced suggests that extrinsic factors lead to induction of CEACAM5 in negative cells. EMT and EMT/MET suggest that disseminating tumor cells undergo epithelial to mesenchymal transition (EMT) without or with subsequent mesenchymal to epithelial transition (MET), respectively. Hierarchy-based suggests that disseminating cancer stem cells retain their differentiation capacity. Credit Correspondence to - René Villadsen - r.villadsen@sund.ku.dk Usage Restrictions Copyright: © 2020 Bechmann et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. License Licensed content Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.