The sentinel node in breast cancer: acceptable false-negative rate

Abstract

that the technique had a 20% false-negative rate. If the surgeon was not willing to use this test, he was asked successively whether he would use it, if it had a 10%, 5%, or 1% false-negative rate. The second case (T1b) involved a 0·9 cm tumour and the third case concerned a similar patient but with a 2·5 cm tumour (T2). For the first case, two surgeons refused to use the technique even if it had only a 1% false-negative rate, whereas six (40%) and 12 (80%) were reluctant if the method had respectively a 5% or 10% false-negative rate. The accepted false-negative rate was even lower for a breast cancer patient with a stage T1b or a stage T2 (table). To assess patient preference, we also interviewed 27 women, all working at a university hospital (12 physicians and 15 paramedics). They all had a high level of understanding of the subject as they were all directly or indirectly professionally involved in the management of patients with breast cancer. After ensuring that the problem was well understood, they were asked which false-negative rates would be acceptable. Most of the interviewed women (85%) preferred having the nodes systematically removed, disregarding the false negative rate of the sentinel-node approach. They also maintained their opinion regardless of the rate of lymphoedema associated with node removal. A disconcerting contrast exists between, on the one hand, the enthusiasm of some surgeons who advocate using, in early breast cancer, the sentinel-node technique instead of the classical node dissection, and, on the other hand, the low degree of acceptance by breast-cancer surgeons of falsenegative rates. It should be noted that the considered acceptable false-negative rate is lower than what has been previously published by some investigators. , 3 Such a low falsenegative rate is unlikely to exist in the clinical practice. Even more disturbing is the preference indicated by potential patients, the women interviewed in this work. Most of them were not willing to accept the slightest risk of false-negative rates. Though these women are not representative of patients with breast cancer, we hypothesise that breast-cancer patients will be even more reluctant to take the risk of not removing nodes; their level of understanding will often be lower, and they will have to be informed in emotionally much more The sentinel node in breast cancer: acceptable false-negative rate