Causes of false-negative sentinel node biopsy in patients with breast cancer

Andersson, Yvette; Frisell, Jan; Sylvan, M.; Boniface, Jana de; Bergkvist, Leif

doi:10.1002/bjs.9085

Cited by 15 publications

(14 citation statements)

References 56 publications

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“…In addition, there were several significant baseline differences between the two groups, which in large part can be explained by the underlying selection mechanisms for the surgical methods studied. Multifocality, for example, is a known contributor to the surgical choice of mastectomy, but may at the same time represent both a risk factor for a false‐negative sentinel node biopsy and for worse prognosis. This factor, however, was not identified as an independent predictor in the adjusted analyses, which is in line with publications reporting that the type of surgery might not influence the association between multifocality and worse tumour characteristics and outcome.…”

Section: Discussionsupporting

confidence: 81%

Breast-conserving surgery followed by whole-breast irradiation offers survival benefits over mastectomy without irradiation

Boniface

Frisell

Bergkvist

et al. 2018

British Journal of Surgery

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BackgroundThe prognostic equivalence between mastectomy and breast‐conserving surgery (BCS) followed by radiotherapy was shown in pivotal trials conducted decades ago. Since then, detection and treatment of breast cancer have improved substantially and recent retrospective analyses point towards a survival benefit for less extensive breast surgery. Evidence for the association of such survival data with locoregional recurrence rates is largely lacking.MethodsThe Swedish Multicentre Cohort Study prospectively included clinically node‐negative patients with breast cancer who had planned sentinel node biopsy between 2000 and 2004. Axillary lymph node dissection was undertaken only in patients with sentinel node metastases. For the present investigation, adjusted survival analyses were used to compare patients who underwent BCS and postoperative radiotherapy with those who received mastectomy without radiotherapy.ResultsOf 3518 patients in the Swedish Multicentre Cohort Study, 2767 were included in the present analysis; 2338 had BCS with postoperative radiotherapy and 429 had mastectomy without radiotherapy. Median follow‐up was 156 months. BCS followed by whole‐breast irradiation was superior to mastectomy without irradiation in terms of both overall survival (79·5 versus 64·3 per cent respectively at 13 years; P < 0·001) and breast cancer‐specific survival (90·5 versus 84·0 per cent at 13 years; P < 0·001). The local recurrence rate did not differ between the two groups. The axillary recurrence‐free survival rate at 13 years was significantly lower after mastectomy without irradiation (98·3 versus 96·2 per cent; P < 0·001).ConclusionThe present data support the superiority of BCS with postoperative radiotherapy over mastectomy without radiotherapy. The axillary recurrence rate differed significantly, and could be one contributing factor in a complex explanatory model.

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Section: Discussionsupporting

confidence: 81%

Breast-conserving surgery followed by whole-breast irradiation offers survival benefits over mastectomy without irradiation

Boniface

Frisell

Bergkvist

et al. 2018

British Journal of Surgery

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“…Other risk factors such as tumor location [ 12 , 13 ] and the number of dissected SLNs [ 12 , 15 , 17 ] were also shown to be significant risk factors for a FN in other studies. Our findings are concordant with previous studies that FN results are more likely to be observed when a tumor is located in the upper outer quadrant of the breast and when only a single SLN is harvested.…”

Section: Discussionmentioning

confidence: 94%

“…There are several studies that have identified clinical factors predictive of a FN in a SLNB [ 12 - 17 ]. They mentioned tumor size, multifocal-multicentric disease, location of tumor, and number of removed SLN as risk factors.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for a False-Negative Result of Sentinel Node Biopsy in Patients with Clinically Node-Negative Breast Cancer

Lee

et al. 2018

Cancer Res Treat

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PurposeAlthough sentinel lymph node biopsy (SLNB) can accurately represent the axillary lymph node (ALN) status, the false-negative rate (FNR) of SLNB is the main concern in the patients who receive SLNB alone instead of ALN dissection (ALND).Materials and MethodsWe analyzed 1,886 patientswho underwent ALND after negative results of SLNB, retrospectively. A logistic regression analysis was used to identify risk factors associated with a false-negative (FN) result. Cox regression model was used to estimate the hazard ratio of factors affecting disease-free survival (DFS).ResultsTumor located in the upper outer portion of the breast, lymphovascular invasion, suspicious node in imaging assessment and less than three sentinel lymph nodes (SLNs) were significant independent risk factors for FN in SLNB conferring an adjusted odds ratio of 2.10 (95% confidence interval [CI], 1.30 to 3.39), 2.69 (95% CI, 1.47 to 4.91), 2.59 (95% CI, 1.62 to 4.14), and 2.39 (95% CI, 1.45 to 3.95), respectively. The prognostic factors affecting DFS were tumor size larger than 2 cm (hazard ratio [HR], 1.86; 95% CI, 1.17 to 2.96) and FN of SLNB (HR, 2.51; 95% CI, 1.42 to 4.42) in SLN-negative group (FN and true-negative), but in ALN-positive group (FN and true-positive), FN of SLNB (HR, 0.64; 95% CI, 0.33 to 1.25) did not affect DFS.ConclusionIn patients with risk factors for a FN such as suspicious node in imaging assessment, upper outer breast cancer, less than three harvested nodes, we need attention to find another metastatic focus in non-SLNs during the operation. It may contribute to provide an exact prognosis and optimizing adjuvant treatments.

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“…Anderson et al re-evaluate FFPE tissue blocks of SNs and undiagnosed metastases of SNs are discovered in 18% patients with metastasis at ALND or subsequent axillary recurrence. In the patients without any axillary recurrence, 11% patients have undiagnosed metastases in SNs during reevaluation [25]. Underestimation of lymph node staging is possible in SLNB.…”

Section: Discussionmentioning

confidence: 99%

Non-Inferiority of Survival in Early Breast Cancer Patients with False-Negative Sentinel Nodes After Completing Axillary Lymph Node Dissection

Loh

Lee

Chen

et al. 2020

Preprint

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Background Sentinel lymph node biopsy (SLNB) is standard approach of axillary region for early breast cancer patients with clinically negative node. The present study investigated patients with false-negative sentinel nodes (FNSN) of intraoperative frozen section.Methods A case-control study with 1:3 ratio was conducted. FNSN was diagnosed as negative sentinel nodes (SNs) in frozen sections, but positive for metastasis in formalin-fixed paraffin-embedded (FFPE) blocks. Control was defined no metastasis of SNs in both frozen and FFPE sections.Results Total 20 FNSN cases and 60 matched-controls were enrolled from 333 SLNB patients between April 1, 2005 and November 31, 2009. The demographics and intrinsic subtypes of breast cancer were similar between FNSN and controls. The FNSN patients had a larger tumor size in preoperative mammography and more lymphatic tumor emboli in core biopsy (P-value 0.033 and < 0.001, respectively). Four FNSN patients had metastasis in the non-relevant SNs. Other 16 FNSN patients had results of benign lymphoid hyperplasia of SNs in frozen sections and metastasis in FFPE blocks. Micrometastasis (less than 2 mm) was detected in seven of 16 patients and metastases in non-sentinel nodes was recognized in two of 16 patients. All FNSN patients received second operation with axillary lymph node dissection (ALND). After a median follow-up of 143 months, no FNSN patients developed recurrence of breast cancer. The disease-free survival, disease-specific survival, and overall survival in FNSN were non-inferior than controls.Conclusion Outcomes of FNSN patients after completing ALND was non-inferior to those without metastasis in SNs. ALND improved survival of patients with metastasis non-sentinel ALNs. However, omitting ALND had no effect for those have only micrometastasis in SNs.

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Causes of false-negative sentinel node biopsy in patients with breast cancer

Abstract: SLN serial sectioning contributes to a higher rate of detection of SLN metastasis. The rate of upstaging of the tumour is similar in false- and true-negative groups of patients.

Cited by 15 publications

References 56 publications

Breast-conserving surgery followed by whole-breast irradiation offers survival benefits over mastectomy without irradiation

Breast-conserving surgery followed by whole-breast irradiation offers survival benefits over mastectomy without irradiation

Risk Factors for a False-Negative Result of Sentinel Node Biopsy in Patients with Clinically Node-Negative Breast Cancer

Non-Inferiority of Survival in Early Breast Cancer Patients with False-Negative Sentinel Nodes After Completing Axillary Lymph Node Dissection

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