Non-visualized sentinel nodes in breast cancer patients; prevalence, risk factors, and prognosis

Verheuvel, Nicole C.; Voogd, Adri C.; Tjan‐Heijnen, Vivianne C. G.; Siesling, Sabine; Roumen, R.

doi:10.1007/s10549-017-4483-2

Cited by 7 publications

(12 citation statements)

References 28 publications

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“…In studies conducted by Verheuvel et al and involving a group of 76 472 breast cancer patients who underwent SLNB, a failure to identify the sentinel lymph node occurred in 2.5% of performed procedures . The obtained percentage of non‐vSLN is therefore similar to the value reported by us.…”

Section: Discussionsupporting

confidence: 86%

“…The obtained percentage of non‐vSLN is therefore similar to the value reported by us. The main causes increasing the percentage of SLNB failures in a statistically significant manner included a higher patient's age and a higher stage of metastatic lesions in the axillary lymph nodes ( P < .001), as well as a large size of the primary tumor ( P = .0030) . According to Dordea et al, they also include obesity, which increases a risk of fatty axillary lymph nodes …”

Section: Discussionmentioning

confidence: 99%

“…When compared to patients after SLN resection (visualized sentinel lymph node—vSLN), the rate of metastatic lesions in axillary lymph nodes is significantly higher in non‐vSLN patients. This concerns, in particular, cases of metastases diagnosed in at least three lymph nodes (extensive nodal involvement), found in 13.0%‐37.2% non‐vSLN patients ( P < .001) . In those patients, a direct consequence of a higher clinical stage of disease is a much higher risk of less favorable delayed treatment outcomes (especially, for overall survival; P = .015) …”

Section: Introductionmentioning

confidence: 99%

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Failure of sentinel lymph node mapping in breast cancer patients qualified for treatment sparing axillary lymph nodes—Clinical importance and management strategy—One‐center analysis

et al. 2020

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Sentinel lymph node biopsy (SLNB) is a standard in diagnostic and therapeutic management of patients with nonadvanced invasive breast cancer. The aim of this paper was to evaluate the clinical importance of the failure of sentinel lymph node (SLN) identification during SLNB performed to spare axillary lymph nodes. A total of 5396 patients with invasive breast cancer qualified for SLNB, treated in a period from Jan 2004 to June 2018. All cases of the failure of SLN identification and reasons underlying this situation were analyzed retrospectively. In 196 (3.6%) patients, SLN was not identified (group I), and this resulted in a simultaneous axillary lymph node dissection. 48.5% patients from this group were diagnosed with cancer metastases to lymph nodes (vs 23.6% patients with SLN removed-group II, P < .00001)-stage pN1 in 44.2% of the cases, stage pN2 in 22.1% of the cases, and pN3 in 33.7% (in group II-73.4%, 19.5% and 7.1%, respectively), with a presence of extracapsular infiltration in 68.4% patients (vs 41.7% in group II) and with a significantly higher percentage of micrometastatic nature in group II (17.0%, vs 3.2% in group I). The failure of intraoperative sentinel lymph node mapping indicates a significantly increased risk of breast cancer metastases to the axillary lymph system. At the same time, it can also indicate higher cancer stage and its increased aggressiveness. For this reason, in such situation performance of axillary lymph node dissection still appears to be the approach most advantageous for patients. K E Y W O R D Sbreast cancer, sentinel lymph node biopsy, sentinel lymph node identification, sentinel lymph node metastasis

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Failure of sentinel lymph node mapping in breast cancer patients qualified for treatment sparing axillary lymph nodes—Clinical importance and management strategy—One‐center analysis

et al. 2020

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“…To our knowledge, this is the first study that compared the SLNB results and patient outcome of procedures with SLN visualization and those with persistent nonvisualization after lymphoscintigraphy plus SPECT/CT or reinjection. Verheuvel et al demonstrated that SLNB procedures in which the SLN could not be identified had a worse OS (HR, 1.42; 95% CI, 1.15‐1.75) compared with those with successful SLN identification. In our study, no statistical difference in OS was found between both tumor‐negative SLNB procedure with SLN visualization and those with persistent nonvisualization (Figure ), despite having relatively more procedures with failed SLN identification, and older patients in the tumor‐negative SLNB group with persistent nonvisualization.…”

Section: Discussionmentioning

confidence: 99%

Sentinel lymph node nonvisualization after intratumoral radioisotope tracer injection in breast cancer is not associated with a higher nodal metastasis rate or worse outcomes

Hellingman

Veen

Wan

et al. 2018

Journal of Surgical Oncology

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Background and Objectives Preoperative lymphoscintigraphy does not always visualize a sentinel lymph node (SLN). The study aim was to investigate whether persistent nonvisualization after additional single‐photon emission computed tomography (SPECT)/CT or a second radiotracer injection in breast cancer patients is associated with nodal metastases or worse outcome due to potential understaging and consequently undertreatment. Methods Altogether 2042 consecutive SLN procedures were evaluated. All patients were clinically node‐negative, underwent axillary ultrasound and fine‐needle aspiration cytology (US/FNAC) of suspicious nodes. Lymphoscintigraphy was performed at 3 to 4 hours after intratumoral injection of 99mTc‐nanocolloid. SPECT/CT or a reinjection was performed when initial lymphoscintigraphy showed nonvisualization. Results Persistent nonvisualization was seen in 170 of 2042 procedures (8.3%). The nodal metastasis rate was 16.0% vs 18.0% for procedures with nonvisualization vs SLN visualization, respectively (P = 0.593). The regional recurrence rate of tumor‐negative SLN biopsy procedures was equal between the nonvisualization (0.7%, 11 of 1535) vs visualization (0.7%, 1 of 144) group. Median follow‐up was 48 months. Distant–metastasis free interval and overall survival was not significantly different between both groups ( P = 0.164 and 0.208, respectively). Conclusions Persistent nonvisualization after lymphoscintigraphy plus SPECT/CT or radiotracer reinjection is not associated with a higher nodal metastasis rate or worse long term outcome when preoperative US/FNAC is performed.

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“…Studies of the incidence of locoregional recurrence or DR after IBTR have reported rates ranging from 15 to 71 per cent. Voogd and colleagues reported a 5‐year DR rate of 55·8 per cent in a cohort of patients with IBTR, initially treated between 1980 and 1992.…”

Section: Discussionmentioning

confidence: 99%

Prognostic impact of repeat sentinel lymph node biopsy in patients with ipsilateral breast tumour recurrence

Poodt

Vugts

Schipper

et al. 2019

British Journal of Surgery

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Background: Ipsilateral breast tumour recurrence (IBTR) has an unfavourable prognosis, with a significant subsequent risk of distant recurrence. Repeat sentinel lymph node biopsy (rSLNB) has recently been demonstrated to be technically feasible and useful in tailoring adjuvant treatment plans in patients with IBTR. The prognostic impact of rSLNB in patients with IBTR remains unclear. This study analysed the risk of distant recurrence after IBTR, and evaluated the prognostic impact of rSLNB and other patient and tumour characteristics on distant recurrence-free survival. Methods: Data were obtained from the SNARB (Sentinel Node and Recurrent Breast Cancer) study. Cox proportional hazards analyses were performed to assess the prognostic effect of tumour, patient and treatment factors on distant recurrence-free survival.Results: Of the 515 included patients, 230 (44⋅7 per cent) had a tumour-negative rSLNB and 46 (8⋅9 per cent) a tumour-positive rSLNB. In 239 patients (46⋅4 per cent) the rSLNB procedure was unsuccessful. After a median follow-up of 5⋅1 years, 115 patients (22⋅3 per cent) had developed a recurrence. The overall 5-year distant recurrence-free survival rate was 84⋅2 (95 per cent c.i. 80⋅7 to 87⋅7) per cent. An interval of less than 2 years between primary breast cancer treatment and ipsilateral recurrence (P = 0⋅018), triple-negative IBTR (P = 0⋅045) and absence of adjuvant chemotherapy after IBTR (P = 0⋅010) were independently associated with poor distant recurrence-free survival. The association between the outcome of rSLNB and distant recurrence-free survival was not statistically significant (P = 0⋅682). Conclusion:The outcome of rSLNB is not an important prognostic factor for distant recurrence, and its value as a staging tool in patients with IBTR seems disputable.Members of the SNARB study group are co-authors in this study and are listed in Appendix S1 (supporting information)

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Non-visualized sentinel nodes in breast cancer patients; prevalence, risk factors, and prognosis

Cited by 7 publications

References 28 publications

Failure of sentinel lymph node mapping in breast cancer patients qualified for treatment sparing axillary lymph nodes—Clinical importance and management strategy—One‐center analysis

Failure of sentinel lymph node mapping in breast cancer patients qualified for treatment sparing axillary lymph nodes—Clinical importance and management strategy—One‐center analysis

Sentinel lymph node nonvisualization after intratumoral radioisotope tracer injection in breast cancer is not associated with a higher nodal metastasis rate or worse outcomes

Prognostic impact of repeat sentinel lymph node biopsy in patients with ipsilateral breast tumour recurrence

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