Sentinel-Node Biopsy to Avoid Axillary Dissection in Breast Cancer with Clinically Negative Lymph-Nodes

Abstract

Background. Axillary lymph‐node dissection is an important staging procedure in the surgical treatment of breast cancer. However, early diagnosis has led to increasing numbers of dissections in which axillary nodes are free of disease. This raises first, questions about the need for the procedure. We carried out a study to assess, first, whether a single axillary lymph node (sentinel node) initially receives malignant cells from a breast carcinoma and, second, whether a clear sentinel node reliably forecasts a disease‐free axilla. Methods. In a consecutive series of 163 women with operable breast carcinoma, we injected microcolloidal particles of human serum albumin labelled with technetium‐99m. This tracer was injected subdermally, close to the tumor site, on the day before surgery, and scintigraphic images of the axilla and breast were taken 10 min, 30 min, and 3 h later. A mark was placed on the skin over the site of the radioactive node (sentinel node). During breast surgery, a hand‐held γ‐ray det$ector probe was used to locate the sentinel node, and make possible its separate removal via a small axillary incision. Complete axillary lymphadenectomy was then done. The sentinel node was tagged separately from other nodes. Permanent sections of all removed nodes were prepared for pathological examination. Findings. From the sentinel node, we could accurately predict axillary lymph‐node status in 156 (97.5%) of the 160 patients in whom a sentinel node was identified, and in all cases (45 patients) with tumours less than 1.5 cm in diameter. In 32 (38%) of the 85 cases with metastatic axillary nodes, the only positive node was the sentinel node. Interpretation. In the large majority of patients with breast cancer, lymphoscintigraphy and γ‐probe‐guided surgery can be used to locate the sentinel node in the axilla, and thereby provide important information about the status of axillary nodes. Patients without clinical involvement of the axilla should undergo sentinel‐node biopsy routinely, and may be spared complete axillary dissection when the sentinel node is disease‐free.

False negative rate for intraoperative sentinel lymph node frozen section in patients with breast cancer: a retrospective analysis of patients in a single Asian institution

“…Size of SLN metastases as well as histological subtype were identified as significant predictors of FNR. This is consistent with results from multiple published studies,2 18 19 21 with many authors concluding that the failure of FS diagnosis was in the detection of micrometastatic disease and ITCs.…”

Sentinel node investigation in breast cancer: detailed analysis of the yield from step sectioning and immunohistochemistry

“…Because validation studies have shown high accuracy rates for the SN procedure, [4][5][6][7][8][9] it can now be used as a staging procedure without the need for complete axillary lymph node dissection in patients with a negative SN. 1 Provided that the surgeon has performed a reliable SN biopsy procedure, it is up to the pathologist to determine whether axillary metastases are present or not.…”

“…1-3 When the SN is identified successfully, the absence of tumour in this node predicts with a high degree of accuracy the absence of metastases in the remaining axillary lymph nodes. [4][5][6][7][8][9] The reliability of the SN procedure as an accurate staging procedure is dependent on the ability to identify the true SN and the extent of histopathological examination of the SN. Both are instrumental in limiting the false negative rate of the SN procedure.…”

Assessment of sentinel lymph node in cervical cancer: review of literature: Figure 1

“…Currently, this procedure is being widely used in melanoma and breast cancer. The role of sentinel lymph node biopsy is being investigated in other applications such as cervical and vulvar malignancies 12 30 31 32 33…”