Increased False Negative Rates in Sentinel Lymph Node Biopsies in Patients with Multi-Focal Breast Cancer

Abstract

There are few data about the reliability of sentinel node biopsy in patients with multi-focal breast cancer. The aim of this study was to determine the factors affecting the identification and accuracy of the sentinel node, comparing multifocality with other variables, using peritumoral isosulfan blue dye injection technique alone. Between 1998 and 2001, 122 patients with clinically negative nodes from a single institute were eligible for sentinel lymph node biopsies (SLNBs). All patients underwent conventional axillary lymph node dissection (ALND). SLNs were identified in 111 of 122 (91%) cases, and analyzed by hematoxylin and eosin. Twenty-one patients with multifocal breast cancer were determined by clinical or pathologic examination (gross or microscopic). Success in locating the sentinel node was unrelated to patient's age, tumor size, type, location, histological or nuclear grade, multifocality, or a previous surgical biopsy. SLNBs accurately predicted the status of the axilla in 104 of the 111 patients (93.7%), while 18 of the 21 patients with multi-focal breast cancer (85.7%) had successful lymphatic mapping. The false negative (FN) rate was 11.3% among patients with successful SLNBs. Multifocality and tumor size (>2 cm) were associated significantly with decreased accuracy and increased FN rates (for multifocality, p = 0.007 and p = 0.006, and for tumor size >2 cm, p = 0.04 and p = 0.05, respectively) in binary logistic regression analysis, whereas excisional biopsy, tumor location in the upper outer quadrant and patient's age did not significantly affect the accuracy and FN rates in univariate analysis. These results suggest sentinel lymph node biopsy using peritumoral isosulfan blue injection method alone can accurately predict axillary status in patients with clinically negative nodes, but patients with multi-focal disease and large tumor size may not be ideal candidates.

Factors predicting the sentinel and non-sentinel lymph node metastases in breast cancer

“…Therefore, accurate staging is necessary to determine the prognosis and the need for adjuvant therapy in patients [3,4]. Sentinel lymph node (SLN) biopsy has evolved as a technique for staging accurately the axilla with less morbidity than routine axillary lymph node dissection (ALND) in breast cancer [5][6][7][8][9][10][11][12][13][14]. Because the non-SLNs were found unlikely to be involved, if the SLNs are negative [15][16][17][18], completion, axillary dissections (CAD) are not routinely performed, and randomized trials are ongoing to validate omission of CADs in those patients [19,20].…”

Lymphoscintigraphy and SPECT/CT in multicentric and multifocal breast cancer: does each tumour have a separate drainage pattern?

“…In view of these numbers, accurate staging seems particularly relevant in patients with multiple malignancies within one breast. Yet the reported false-negative rate of sentinel node biopsy is high [7,24,25]. Ozmen et al found a significant association between multicentric/multifocal disease and a false-negative procedure and Fearmonti et al particularly mention the risk of a falsenegative procedure in those with a large additive tumour burden [24,25].…”

“…Yet the reported false-negative rate of sentinel node biopsy is high [7,24,25]. Ozmen et al found a significant association between multicentric/multifocal disease and a false-negative procedure and Fearmonti et al particularly mention the risk of a falsenegative procedure in those with a large additive tumour burden [24,25]. A recent prospective multiinstitutional study by Giard et al showed a 13.6% false-negative rate of sentinel node biopsy after a single tracer injection in the breast [7].…”

Non-axillary breast cancer recurrences after sentinel node biopsy

“…Examples are previous surgery of the breast or axilla (Case 4), multicentricity [12][13][14], and extensive ductal carcinoma in situ. Ductal carcinoma in situ should not metastasize by definition, but in some 6% of these patients metastases are found in sentinel nodes.…”