Improved false negative rate of axillary status using sentinel lymph node biopsy and ultrasound-suspicious lymph node sampling in patients with early breast cancer.

Yulong Wang,Hongqiang Chen,Kai Yuan,Rongzhan Fu,Li Zhang,Mingwen Jiao,Haiyan Dong,Hongyan Wu

doi:10.1186/s12885-015-1331-9

Abstract

BackgroundThe false negative rate of sentinel lymph node biopsy (SLNB) is 5-10%, and results in improper patient management. The study was to assess the value of ultrasound-suspicious axillary lymph node biopsy (USALNB) in patients with early breast cancer, and to compare SLNB combined with USALNB (SLNB + USALNB) with SLNB alone.MethodsFrom January 2010 to July 2013, 216 patients with early breast cancer were enrolled consecutively at the Department of Breast and Thyroid Surgery, Qianfoshan Hospital, Shandong University. All patients underwent wire localization of the suspicious node by color Doppler ultrasonography, followed by SLNB 2–3 hours later, suspicious node lymphadenectomy, and level ≥ II axillary dissection (as the gold standard). The predictive values of node status between SLNB + USALNB and SLNB alone were compared.ResultsThe success rate of SLNB was 99.1% (214/216). After axillary dissection, 71 patients were confirmed with axillary lymph node metastases by pathological examinations. Eight false negatives were observed using SLNB alone, resulting in sensitivity of 88.7%, specificity of 100%, false negative rate of 11.3%, and false positive rate of 0% in predicting the axillary node status. SLNB + USALNB resulted in sensitivity of 97.2%, specificity of 100%, false negative rate of 2.8%, and false positive rate of 0%. The false negative rate of SLNB + USALNB was significantly different from that of SLNB alone (P = 0.031).ConclusionsSLNB + USALNB seems to be a low-risk procedure that might be useful in reducing the false negative rate of SLNB, improving the accuracy of axillary nodes evaluation in early breast cancer.

Highlights

The false negative rate of sentinel lymph node biopsy (SLNB) is 5-10%, and results in improper patient management
Wang et al BMC Cancer (2015) 15:382 used ultrasound to identify suspicious axillary lymph nodes (SALN) and to sample them, either using fine needle aspiration (FNA) and/or core needle biopsy, and showed relatively good predictive value for axillary status [5,6,7]. Most of these studies tested the use of ultrasound-guided SALN biopsy (USALNB) instead of SLNB, and the use of ultrasound-suspicious axillary lymph node biopsy (USALNB) alone is associated with highly variable false positive rates [5] that may impair its use in a clinical setting
Recent studies using large randomized samples, such as the ALMANAC [14] and NSABP B-32 [15] trials, have shown that the false negative rate of the axillary lymph node status predicted by SLNB was 5-10%

Summary

Introduction

The false negative rate of sentinel lymph node biopsy (SLNB) is 5-10%, and results in improper patient management. Wang et al BMC Cancer (2015) 15:382 used ultrasound to identify SALN and to sample them, either using fine needle aspiration (FNA) and/or core needle biopsy, and showed relatively good predictive value for axillary status [5,6,7]. Most of these studies tested the use of ultrasound-guided SALN biopsy (USALNB) instead of SLNB, and the use of USALNB alone is associated with highly variable false positive rates [5] that may impair its use in a clinical setting. The use of ultrasound to detect the SALN was shown to reduce the reoperation rate [8,9]

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