Feasibility of sentinel lymph node biopsy in breast cancer patients clinically suspected of axillary lymph node metastasis on preoperative imaging

Hee Yong Kwak,Byung Joo Song,Byung Joo Chae,Sang Hoon Kim,Eun Jin Kim,Sang Seol Jung,Ja Seong Bae,Eun Young Chang

doi:10.1186/1477-7819-11-104

Hee Yong Kwak, Byung Joo Song + Show 6 more

Open Access

https://doi.org/10.1186/1477-7819-11-104

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Abstract

BackgroundGenerally, sentinel lymph node biopsy (SLNB) is performed in patients with clinically negative axillary lymph node (LN). This study was to assess imaging techniques in axillary LN staging and to evaluate the feasibility of SLNB in patients clinically suspected of axillary LN metastasis on preoperative imaging techniques (SI).MethodsA prospectively maintained database of 767 breast cancer patients enrolled between January 2006 and December 2009 was reviewed. All patients were offered preoperative breast ultrasound, magnetic resonance imaging, and positron emission tomography scanning. SI patients were regarded as those for whom preoperative imaging was “suspicious for axillary LN metastasis” and NSI as “non-suspicious for axillary LN metastasis” on preoperative imaging techniques. Patients were subgrouped by presence of SI and types of axillary operation, and analyzed.ResultsFor 323 patients who received SLNB, there was no statistically significant difference in axillary recurrence (P=0.119) between SI and NSI groups. There also was no significant difference in axillary recurrence between SLNB and axillary lymph node dissection (ALND) groups in 356 SI patients (P=0.420). The presence of axillary LN metastasis on preoperative imaging carried 82.1% sensitivity and 45.9% specificity for determining axillary LN metastasis on the final pathology.ConclusionsSLNB in SI patents is safe and feasible. Complications might be avoided by not performing ALND. Therefore, we recommend SLNB, instead of a direct ALND, even in SI patients, for interpreting the exact nodal status and avoiding unnecessary morbidity by performing ALND.

Highlights

Sentinel lymph node biopsy (SLNB) is performed in patients with clinically negative axillary lymph node (LN)
sentinel lymph node biopsy (SLNB) has been recommended based on the results of recent randomized clinical trials showing decreased arm and shoulder morbidity in patients with breast cancer undergoing SLNB compared with those undergoing standard axillary lymph node dissection
SLNB is still not recommended by the American Society of Clinical Oncology (ASCO) for large or locally advanced invasive breast cancers (T3 and T4), inflammatory breast cancer, during pregnancy, in the setting of prior non-oncologic breast surgery or axillary surgery, and in the presence of suspicious palpable axillary LN

Summary

Introduction

Sentinel lymph node biopsy (SLNB) is performed in patients with clinically negative axillary lymph node (LN). This study was to assess imaging techniques in axillary LN staging and to evaluate the feasibility of SLNB in patients clinically suspected of axillary LN metastasis on preoperative imaging techniques (SI). Sentinel lymph node biopsy (SLNB) is the preferred method to assess the pathologic status of the axillary lymph nodes (LNs) for patients with stage I or II breast cancer [1,2,3,4,5,6,7,8]. According to the National Comprehensive Cancer Network (NCCN) guideline, SLNB should be performed in patients with clinically negative axillary LNs [10]. In the ASCO guideline recommendations, the sensitivity of SLN biopsy for node involvement ranged from 71% to

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