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

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.

Indocyanine green detects sentinel lymph nodes in early breast cancer

“… 2 The presence or absence of axillary lymph node involvement represents one of the most important prognostic indicators of long-term patient outcome for breast cancer. 3 – 5 This demonstrates the importance of sentinel lymph node (SLN) identification during surgery in breast cancer patients. Currently, sentinel lymph node biopsy (SLNB) is considered the first option for breast cancer axillary lymph node staging evaluation because of its reduced morbidity compared with axillary lymph node dissection (ALND).…”

“…Currently, sentinel lymph node biopsy (SLNB) is considered the first option for breast cancer axillary lymph node staging evaluation because of its reduced morbidity compared with axillary lymph node dissection (ALND). 3 However, a false negative rate of 5–10% was reported for SLNB. 6 , 7 Multiple techniques proposed for detecting SLNs use a dye or a gamma probe, alone or in combination.…”

Accuracy of Sentinel Lymph Node Biopsy after Neoadjuvant Chemotherapy in Breast Cancer Patients; Single Center Experience

“…The factors affecting the rate of false negative results during are multiple including SLNB technique, variability in lymphatic drainage pathway, level of surgeon experience and patient selection [24].…”

Evaluation of a Novel Hand Held Gamma Camera for Intra-Operative Single Photon Emission Computed Tomography

“…A meta-analysis carried out to evaluate the significance of false negative rate (FNR) of sentinel lymph node biopsy in patients with breast cancer concludes that blue dye alone method has the highest FNR. This can be significantly lowered to 5% to 10% using radiotracer along with the blue dyes to detect the sentinel nodes [35], [36]. But intraoperative external gamma probe counting requires some skill for accurate identification of the SLN.…”

“…The false negative rate in SLNB is reported to be 5% to 10% [35], [36]. It is possible that such performance can be improved upon and the process simplified by using technology that will allow intraoperative visualization of the activity distribution in the anatomic region of interest.…”