Abstract

BackgroundAlthough sentinel lymph node biopsy (SLNB) can accurately predict the status of axillary lymph node (ALN) metastasis, the high false-negative rate (FNR) of SLNB is still the main obstacle for the treatment of patients who receive SLNB instead of ALN dissection (ALND). The purpose of this study was to evaluate the clinical significance of SLNB combined with peripheral lymph node (PLN) sampling for reducing the FNR for breast cancer and to discuss the effect of “skip metastasis” on the FNR of SLNB.MethodsAt Shandong Cancer Hospital Affiliated to Shandong University between March 1, 2012 and June 30, 2015, the sentinel lymph nodes (SLNs) of 596 patients with breast cancer were examined using radiocolloids with blue dye tracer. First, the SLNs were removed; then, the area surrounding the original SLNs was selected, and the visible lymph nodes in a field of 3–5 cm in diameter around the center (i.e., PLNs) were removed, avoiding damage to the structure of the breast. Finally, ALND was performed. The SLNs, PLNs, and remaining ALNs underwent pathologic examination, and the relationship between them was analyzed.ResultsThe identification rate of SLNs in the 596 patients was 95.1% (567/596); the metastasis rate of ALNs was 33.7% (191/567); the FNR of pure SLNB was 9.9% (19/191); and after the SLNs and PLNs were eliminated, the FNR was 4.2% (8/191), which was significantly decreased compared with the FNR before removal of PLNs (P = 0.028). According to the detected number (N) of SLNs, the patients were divided into four groups of N = 1, 2, 3, and ≥4; the FNR in these groups was 19.6, 9.8, 7.3, and 2.3%, respectively. For the patients with ≤2 or ≤3 detected SLNs, the FNR after removal of PLNs was significantly decreased compared with that before removal of PLNs (N ≤ 2: 14.0% vs. 4.7%, P = 0.019; N ≤ 3: 12.2% vs. 4.7%, P = 0.021), whereas for patients with ≥4 detected SLNs, the decrease in FNR was not statistically significant (P = 1.000). In the entire cohorts, the “skip metastasis” rate was 2.5% (15/596); the FNR caused by “skip metastasis” was 2.1% (4/191).ConclusionsThe FNR of SLNB was associated with the number of SLNs. For patients with ≤3 detected SLNs, PLN sampling can reduce the FNR of SLNB to an acceptable level of less than 5%. Because of the existence of the “skip metastasis” and distinct metastasis patterns, the FNR of SLNB cannot be completely eliminated.

Highlights

  • Sentinel lymph node biopsy (SLNB) can accurately predict the status of axillary lymph node (ALN) metastasis, the high false-negative rate (FNR) of sentinel lymph node biopsy (SLNB) is still the main obstacle for the treatment of patients who receive SLNB instead of ALN dissection (ALND)

  • Patients with negative ALN status do not benefit from ALND, which increases the incidence of postoperative complications such as lymphedema and sensory and motor dysfunction

  • Patient selection and clinical data The inclusion criteria for patients in the present study were as follows: (1) breast cancer confirmed by fine needle aspiration or biopsy; (2) preoperative clinical examination and imaging examination confirmed that the cases were cN0; (3) no anti-cancer therapy received before surgery; (4) after the SLNs and peripheral lymph node (PLN) were resected, patients underwent level I combined with level II lymph node dissection or complete ALND

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Summary

Introduction

Sentinel lymph node biopsy (SLNB) can accurately predict the status of axillary lymph node (ALN) metastasis, the high false-negative rate (FNR) of SLNB is still the main obstacle for the treatment of patients who receive SLNB instead of ALN dissection (ALND). To accurately stage breast cancer, it is necessary to know a patient’s axillary lymph node (ALN) status. ALN status is one of the most important indicators for determining the prognosis of patients with breast cancer and guiding axillary treatment. Axillary lymph node dissection (ALND) is an important part of the surgical treatment of invasive breast cancer; ALND is the most accurate method of evaluating the status of ALN metastasis. Patients with negative ALN status do not benefit from ALND, which increases the incidence of postoperative complications such as lymphedema and sensory and motor dysfunction. The tumor load of the regional lymph nodes has decreased [3, 4], making it possible to narrow the range of patients who undergo axillary surgery

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