Abstract
PurposeThe goal of sentinel lymph node biopsy is to establish the presence or absence of cancer cells in regional axillary nodes. The number of sentinel nodes harvested from each patient varies. The aim of this study was to determine what factors influence the number of sentinel nodes excised at sentinel node biopsy.MethodsData from 426 patients with breast cancer who underwent sentinel lymph node biopsy at the Edinburgh Breast Unit by 10 different experienced breast surgeons were included in this analysis. Univariate and multivariable statistical analysis was performed.ResultsIn the multivariate analysis the number of sentinel nodes biopsied varied significantly between operating surgeon (p < 0.0001) and was also statistically associated with the use of neoadjuvant chemotherapy (p < 0.0001) and with the number of involved lymph nodes (p < 0.0001). More nodes were removed in patients who received neoadjuvant chemotherapy and had metastases in sentinel lymph nodes.ConclusionsThis study shows that the surgeon plays a pivotal and significant role in determining the numbers of sentinel nodes removed by sentinel lymph node biopsy. Surgeons should monitor their own data on the average numbers of sentinel nodes they remove. Some surgeons may not be removing sufficient numbers of sentinel nodes to maintain a low false negative rate for this procedure.
Highlights
The lymphatic system was discovered in 1653 by Bartholin
A negative sentinel node biopsy assumes no metastasis to any axillary nodes
This study has shown that a variety of factors have an impact on the number of sentinel nodes identified using isotope and blue dye that were removed during sentinel node biopsy
Summary
The lymphatic system was discovered in 1653 by Bartholin. Virchow in the nineteenth century believed that lymph nodes filtered lymph [1]. The spread of cancer cells through the lymphatic system by a defined route stemmed from these. Observations and resulted in the technique of sentinel lymph node biopsy (SLNB). A sentinel node is named after the first guard who stands watch. Lymph flow from the tumour site passes through the first nodes draining the breast known as sentinel nodes [1]. A negative sentinel node biopsy assumes no metastasis to any axillary nodes. Metastatic breast cancer is present when cancer cells involve the sentinel node or nodes [2]. SLNB provides prognostic information and guides adjuvant treatment
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