Abstract
Background: Sentinel lymph node biopsy (SLNB) is standard of care in clinico- radiologically negative axilla in early breast cancer case. It’s an oncologically safe alternative to Axillary lymph node dissection (ALND), however factors predicting sentinel node metastasis in Indian population is lacking. Methods: A prospective observational study which recruited 80 patients with breast cancer who underwent SLNB with or without ALND, with evaluation of predictive factors including size, type and quadrant , hormonal status of breast this characteristics were prospectively analyzed to predict the axillary metastasis and need of SLNB . Result: Mean age of the patients included in our study was 52.4 years. On univariate analysis, size (p<0.013), upper outer quadrant (UOQ) (p<0.038), central quadrant (CQ) (0.07) were significantly associated with axillary node metastasis in T2 tumors. While on multivariate analysis, UOQ (P<0.009), CQ (p<0.02) metastasis were associated with axillary node metastasis in T2 tumors. Overall sensitivity, specificity, positive predictive valve (PPV) and negative predictive valve (NPV) of SLNB in predicting axillary node status was 77.59%, 100%, 100% and 62.86% respectively. The overall accuracy was 83.7%. Conclusion: Upper outer quadrant, central quadrant and size of the tumors are important prognostic factors to predict axillary node metastasis without the need of sentinel node biopsy in early breast cancers.
Highlights
Sentinel lymph node (SLNB) mapping and dissection is a sensitive and accurate technique for nodal evaluation and has been applied to staging of axillary lymph nodes in patients with breast cancer [1]
Its false negative rate is 5% according to Amersi et al, there is increase the risk of recurrence and its controversial in pregnancy, vital blue dye is contraindicated in pregnant patients, or use of radioactive colloid alone to map this subgroup of patients [2]. other relative disadvantages of SNB includes its implication of finding micro metastases in the sentinel nodes, and its effectiveness after neo adjuvant therapy, and in staging of axilla in locally recurrent breast cancer following breast surgery with or without prior axillary surgery
We aimed to find out site and size-specific incidence of ALNM depending on the quadrant of the breast involved
Summary
Sentinel lymph node (SLNB) mapping and dissection is a sensitive and accurate technique for nodal evaluation and has been applied to staging of axillary lymph nodes in patients with breast cancer [1]. Its false negative rate is 5% according to Amersi et al, there is increase the risk of recurrence and its controversial in pregnancy, vital blue dye is contraindicated in pregnant patients, or use of radioactive colloid alone to map this subgroup of patients [2]. other relative disadvantages of SNB includes its implication of finding micro metastases in the sentinel nodes, and its effectiveness after neo adjuvant therapy, and in staging of axilla in locally recurrent breast cancer following breast surgery with or without prior axillary surgery. It’s an oncologically safe alternative to Axillary lymph node dissection (ALND), factors predicting sentinel node metastasis in Indian population is lacking
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