Sentinel lymph node dissection for breast cancer: how many nodes are enough and which technique is optimal?

Woznick, Amy R.; Franco, Marianne; Bendick, Phil; Benitez, Pamela

doi:10.1016/j.amjsurg.2005.10.031

Cited by 47 publications

(22 citation statements)

References 14 publications

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“…Standard techniques for sentinel node biopsy include the radiocolloid method, the blue dye method, and a combination of both [24,25]. Recently, preliminary studies have suggested that SLN biopsy can be guided by fluorescence detection after subareolar injection of ICG.…”

Section: Discussionmentioning

confidence: 99%

ICG fluorescence-guided sentinel node biopsy for axillary nodal staging in breast cancer

Hirche

Murawa

Mohr

et al. 2010

Breast Cancer Res Treat

215

150

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Background: Sentinel lymph node (SLN) biopsy is a selective approach to axillary staging of breast cancer with reduced morbidity. Current detection methods including radioisotope and blue dye show good results but some drawbacks are remaining. Indocyanine green (ICG) fluorescence detection was evaluated as a new method for SLN biopsy in breast cancer allowing both transcutaneous visualization of lymphatic vessels and intraoperative identification of SLN. Methods: Forty-three women with clinically node negative breast cancer received subareolar injection of ICG for fluorescence detection of SLN. All patients underwent either planned axillary lymph node dissection (ALND) with SLN biopsy or selective SLN biopsy to determine need for ALND. Clinical feasibility, detection rate, sensitivity, and axillary recurrence after isolated SLN biopsy were analyzed. Results: Overall ICG fluorescence imaging identified 2.0 SLN in average in 42 of 43 patients (detection rate: 97.7%). Metastatic involvement of the SLN was found in 17 of 18 nodal positive patients by conventional histopathology (sensitivity: 94.4%). Immunohistochemistry revealed isolated tumor cells in five further cases. There was only one false-negative case in 43 patients (5.6%). In 17 of 23 overall nodal positive patients, the SLN was the only positive lymph node. After a median follow-up of 4.7 years none of the patients presented with axillary recurrence. Conclusion: ICG fluorescence imaging is a new method for SLN biopsy in breast cancer with acceptable sensitivity and specificity comparable to conventional methods. One advantage of this technique is that it allows transcutaneous visualization of lymphatic vessels and intraoperative lymph node detection without radioisotope.Keywords Sentinel lymph node biopsy Á Breast cancer Á Indocyanine green (ICG) Á Fluorescence imaging Á Surgery Abbreviations ALND Axillary lymph node dissection ICG Indocyanine green SLN Sentinel lymph node

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Section: Discussionmentioning

confidence: 99%

ICG fluorescence-guided sentinel node biopsy for axillary nodal staging in breast cancer

Hirche

Murawa

Mohr

et al. 2010

Breast Cancer Res Treat

215

150

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“…Although it is known that the false-negative rate (FNR) of SLN biopsy is greater in patients in whom only 1 SLN is removed, 3 controversy exists regarding how many SLNs are sufficient for accurate staging of the axilla. [4][5][6][7] Recently, it has been proposed that the SLN biopsy procedure should be terminated after 3 SLNs are identified. 8 Adoption of such a policy, it is argued, will reduce the cost of the procedure by lessening operative time and decreasing the costs of pathologic analysis.…”

Section: Discussionmentioning

confidence: 99%

“…5 They found that 100% of the SLN metastases could only be found when 13 SLNs were removed. 5 In addition, in a study of 720 patients, Woznick et al 7 found 3% of the 172 SLN-positive patients had their first sign of metastasis in their fourth or higher SLN. In their study, however, only 6 nodes were required to identify all of the SLN metastases.…”

Section: Commentmentioning

confidence: 99%

“…In their study, however, only 6 nodes were required to identify all of the SLN metastases. 7 Although the 2% to 3% rate of finding SLN metastases in higher-order SLNs may seem trivial, it must be understood that this is an incremental rate. In other words, limiting SLN biopsy to a particular threshold would increase the intrinsic FNR of SLN biopsy by 2% to 3%.…”

Section: Commentmentioning

confidence: 99%

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Are 3 Sentinel Nodes Sufficient?

Chagpar

Scoggins²,

Martin³

et al. 2007

Arch Surg

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It has recently been proposed that only 3 sentinel lymph nodes (SLNs) are required for an adequate SLN biopsy. Others have advocated removing all nodes that are blue, hot, at the end of a blue lymphatic channel, or palpably suspicious or that have radioactive counts of 10% or greater of the most radioactive SLN. Our objective was to determine the false-negative rate (FNR) associated with limiting SLN biopsy to 3 nodes.

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“…There was no metastasis in SLNs defined as S4, S5 and so on. The average number of sampling SLNs until detecting metastasis in S1, S2, and S3 was 1.24 (1-4), 2.45 (2-4), and 3.46 (3)(4)(5). Conclusion: During SLNB done using radioisotopes, for accurate axillary lymph node staging, up to the 3rd isotope-count-order of SLNs should be removed.…”

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confidence: 99%

Optimal Sampling Number of Sentinel Lymph Nodes in Invasive Breast Cancer: Results of 1,026 Sentinel Lymph Node Biopsies Done by Radioisotope

et al. 2011

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Purpose: For isotope mapping, many authors have defined the sentinel lymph node (SLN) as the one containing isotope counts higher than the axillary background. However, no study has sought to define an optimal guideline, and the number of SLNs needed for precise detection of metastatic SLNs is still a subject of debate. Accordingly, we set out to determine the optimal sampling number of SLNs. Methods: Between January 2005 and December 2008, we enrolled 1,026 patients with primary invasive breast cancer. These patients had received sentinel lymph node biopsy (SLNB) using radioisotopes at Yeungnam University Hospital. During SLNB, ex vivo isotope counts were measured for each SLN. And, the number and metastatic status of harvested SLNs were investigated. We defined SLNs as lymph nodes that show an isotope count ≥10 times that of the axillary background. Each SLN was labeled as S1 (highest isotope count), S2 (second highest), or S3 and so on, in descending isotopecount-order. If an SLN was positive for metastasis, completion axillary lymph node dissection was performed. Results: The mean age of patients was 48.9 years (ranges, 22-83 years). The mean number of removed SLNs was 2.8 (ranges, 1-11). Of the 1,026 patients enrolled, 311 (30.3%) had SLN metastasis: S1 was positive (S1+) in 258 patients (82.9%), S2 was positive (S1-, S2+) in 40 patients (12.3%), and S3 was positive (S1-, S2-, S3+) in 13 patients (3.9%). There was no metastasis in SLNs defined as S4, S5 and so on. The average number of sampling SLNs until detecting metastasis in S1, S2, and S3 was 1.24 (1-4), 2.45 (2-4), and 3.46 (3-5). Conclusion: During SLNB done using radioisotopes, for accurate axillary lymph node staging, up to the 3rd isotope-count-order of SLNs should be removed. The average number of SLNs needed for detecting metastasis in S3 is four.

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Sentinel lymph node dissection for breast cancer: how many nodes are enough and which technique is optimal?

Cited by 47 publications

References 14 publications

ICG fluorescence-guided sentinel node biopsy for axillary nodal staging in breast cancer

ICG fluorescence-guided sentinel node biopsy for axillary nodal staging in breast cancer

Are 3 Sentinel Nodes Sufficient?

Optimal Sampling Number of Sentinel Lymph Nodes in Invasive Breast Cancer: Results of 1,026 Sentinel Lymph Node Biopsies Done by Radioisotope

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