BS08 SENTINEL NODE BIOPSY IN LARGER OR MULTIFOCAL BREAST CANCERS: TO DO OR NOT TO DO

Abstract

Background The use of sentinel node biopsy in breast cancer patients with large and/or multifocal tumours is controversial.Methods A review of clinical records was undertaken for 213 consecutive patients undergoing sentinel node biopsy for invasive breast cancer from September 2000 to February 2006. The results of sentinel node biopsy and axillary dissection were compared for patients with unifocal or multifocal tumours less than 3 cm or greater than 3 cm. Patient outcomes were also assessed.Results The mean number of sentinel nodes removed per patient increased from 2.33 in 2000 to 4.17 in 2006. For patients with unifocal tumours less than 3 cm, 47/147 (32.0%) were sentinel node positive compared to 15/30 (50%) for multifocal tumours less than 3 cm (p = 0.04), 19/28 (67.9%) for unifocal tumours greater than 3 cm (p < 0.001) and 7/8 (87.5%) for multifocal tumours greater than 3 cm (p = 0.003). Following axillary dissection, 20/48 (41.7%) patients with sentinel node macrometastases were found to have positive non‐sentinel nodes, compared to 4/20 (20.0%) and 1/8 (12.5%) for patients with sentinel node micrometastases and isolated tumour cells. The mean total number of positive nodes was 1.74 compared to 4.21 for unifocal tumours less than or greater than 3 cm respectively (p = 0.005). No axillary recurrences were detected during the follow‐up period.Conclusions Although patients with large and/or multifocal tumours were more likely to have a positive sentinel node, the findings suggest that sentinel node biopsy is safe, accurate and reliable for staging the axilla in these patients.