Sentinel Node Identification Rate and Nodal Involvement in the EORTC 10981-22023 AMAROS Trial

Abstract

BackgroundThe randomized EORTC 10981-22023 AMAROS trial investigates whether breast cancer patients with a tumor-positive sentinel node biopsy (SNB) are best treated with an axillary lymph node dissection (ALND) or axillary radiotherapy (ART). The aim of the current substudy was to evaluate the identification rate and the nodal involvement.MethodsThe first 2,000 patients participating in the AMAROS trial were evaluated. Associations between the identification rate and technical, patient-, and tumor-related factors were evaluated. The outcome of the SNB procedure and potential further nodal involvement was assessed.ResultsIn 65 patients, the sentinel node could not be identified. As a result, the sentinel node identification rate was 97% (1,888 of 1,953). Variables affecting the success rate were age, pathological tumor size, histology, year of accrual, and method of detection. The SNB results of 65% of the patients (n = 1,220) were negative and the patients underwent no further axillary treatment. The SNB results were positive in 34% of the patients (n = 647), including macrometastases (n = 409, 63%), micrometastases (n = 161, 25%), and isolated tumor cells (n = 77, 12%). Further nodal involvement in patients with macrometastases, micrometastases, and isolated tumor cells undergoing an ALND was 41, 18, and 18%, respectively.ConclusionsWith a 97% detection rate in this prospective international multicenter study, the SNB procedure is highly effective, especially when the combined method is used. Further nodal involvement in patients with micrometastases and isolated tumor cells in the sentinel node was similar—both were 18%.

Value of Sentinel Lymph Node Biopsy in Breast Cancer Surgery with Simple Pathology Facilities -An Iranian Local Experience with a Review of Potential Causes of False Negative Results

“…In this study, SLN was the only site of metastasis in 3 cases (10%) opposing to some other studies with incidence of 25-60% (Brenot-Rossi et al, 2003;Krag et al, 2007;Gill 2009;Straver et al, 2010). This could be related to advanced breast cancer with more extensive LN involvement in ALND.…”

“…Similar issue took place about percentage of nodepositive cases, 40%, which is more than expected 20-30% (Krag et al, 2007;Gill 2009;Straver et al, 2010) in patients with early breast cancer. This is most probably due to enrolling symptomatic patients with large tumor lesion and palpable axillary lymphadenopathy which increases likelihood of nodal involvement (Fisher et al, 2002;Leidenius et al, 2005;Blamey et al, 2010).…”

“…Accordingly, when true SLN is totally replaced by tumoral cells or lost its functional compartment, forcing drainage via a collateral, bypasses SLN to a new LN (non-sentinel LN) which necessarily doesn't contain metastases. Many studies and guidelines recommend to perform SLNB in mass lesion less than 2 cm (Veronesi et al, 2010) or 3 cm (Gill 2009;Straver et al, 2010). Without axillary lymphadenopathy to reduce false negative rate.…”

“…Clinical trials have been designed to answer the effect of SLNB on patients' longterm survival (Mansel et al, 2006;Gill 2009;Krag et al, 2010;Straver et al, 2010;Veronesi et al, 2010;) but predictive power of axillary status is well known. It is assessed in the validation period with lymphadenopathy are node-negative and potentially suitable for lymphatic staging by SLNB approach.…”

“…In 2 trials that required surgeons to be trained (Veronesi et al, 2003;Clarke et al, 2004), FN rate has been less than 10% and lower than the GIVOM trial without such a formal experience and with FN rate of 16.7% . It is advised to perform 20-40 completed procedures and meet required set criteria (FN rate less than 5-10% and identification Rate more than 90%) (Clarke et al, 2004;Straver et al, 2010). In addition, FN rate is reduced when surgeon is expert enough to remove as more hot SLNs as possible (Goyal et al, 2006;Krag et al, 2007;.…”