False Negative Rate of Sentinel Lymph Node Biopsy in Multicentric and Multifocal Breast Cancers May be Higher in Cases with Large Additive Tumor Burden

Abstract

We aimed to evaluate the feasibility of sentinel lymph node biopsy (SLNB) in multicentric ⁄ multifocal breast cancer. In this prospective study, 23 women with multicentric ⁄ multifocal breast cancer underwent SLNB at our institution from April 2002 to February 2006. Presence of preoperative axillary metastases was confirmed by FNA. Patients underwent sub-areolar radiopharmaceutical injection ± isosulfan blue to perform SLNB, then completion ALND. The false-negative (FN) rate of SLNB was determined based upon final pathology. Twenty women with multicentric and three with multifocal invasive carcinoma were enrolled. The SLN identification rate was 100%. The overall FN rate of SLNB was 15% (95% CI 0.0466, 0.4281). Both cases with FN SLNB had multicentric disease, pathologic stage III breast cancer and a larger tumor burden compared with the study population. SLNB using sub-areolar injection is feasible for patients with multicentric ⁄ multifocal breast cancer yet may be associated with a higher FN rate in patients with large additive tumor burden.

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

“…In several studies the false‐negative rate was higher in patients with lateral tumours than in those with medial tumours, possibly because lateral isotope injection makes γ probe detection in the adjacent axilla more difficult to perform. The effect of multifocal tumours on the false‐negative rate is debated, although most authors agree that tumour size has no impact.…”

Lymphoscintigraphy and SPECT/CT in multicentric and multifocal breast cancer: does each tumour have a separate drainage pattern?

“…Yet the reported false-negative rate of sentinel node biopsy is high [7,24,25]. Ozmen et al found a significant association between multicentric/multifocal disease and a false-negative procedure and Fearmonti et al particularly mention the risk of a falsenegative procedure in those with a large additive tumour burden [24,25]. A recent prospective multiinstitutional study by Giard et al showed a 13.6% false-negative rate of sentinel node biopsy after a single tracer injection in the breast [7].…”

“…In view of these numbers, accurate staging seems particularly relevant in patients with multiple malignancies within one breast. Yet the reported false-negative rate of sentinel node biopsy is high [7,24,25]. Ozmen et al found a significant association between multicentric/multifocal disease and a false-negative procedure and Fearmonti et al particularly mention the risk of a falsenegative procedure in those with a large additive tumour burden [24,25].…”

Pertinence de la procédure du ganglion sentinelle dans les cancers du sein multifocaux et multicentriques

“…D'une part, car la dé finition de la multifocalité et de la multicentricité é tait diffé rente en fonction des é tudes. D'autre part, la population n'é tait pas la même, certaines é tudes avaient inclus des patientes aprè s chimiothé rapie né o-adjuvante [28], d'autres avaient limité l'inclusion des patientes aux stades T1-T2 et d'autres jusqu'au stade T3, voire T4 [9,12,14,15,17,18,20,22,25,33,34,[42][43][44][45]. La technique du GS é tait é galement variable selon les é tudes concernant le type de marqueur, le site d'injection, le nombre de GS pré levé s, le type d'analyse anatomopathologique du GS.…”