Incidence of Axillary Recurrence in 344 Sentinel Node Negative Breast Cancer Patients after Intermediate Follow-Up. A Prospective Study into the Accuracy of Sentinel Node Biopsy in Breast Cancer Patients

Abstract

Sentinel lymph node biopsy (SLNB) has been validated in the treatment of breast carcinoma and is considered to stage the axilla adequately in this disease. However, long-term follow-up data are scarce. We evaluated the results of SLNB with respect to loco-regional failures in the axilla in SN-negative patients with invasive breast carcinoma and analysed their causal factors. Between 1997 and May 2004, 656 patients without clinically palpable lymph nodes were included in our study. Data with regard to demographics, diagnostics, therapy and follow up were gathered prospectively from all patients. Patients treated after May 2004 were excluded from this study to permit at least one year of follow-up. Out of the 656 patients, 344 patients with a negative sentinel lymph node biopsy did not undergo axillary dissection and were followed up clinically. Median follow up was 43 months. In 3 patients (0.9%) axillary recurrences developed. All three patients subsequently underwent a completion axillary dissection, chemotherapy and radiotherapy. The low rate of clinical axillary recurrence after an intermediate follow up period suggests that a negative SN biopsy accurately reflects the nodal stage in patients with breast cancer.

Nine years of Experience with the Sentinel Lymph Node Biopsy in a Single Italian Center: A Retrospective Analysis of 1,050 Cases

“…Among women who did not undergo CALND after SLNB, axillary recurrence prevalence was 1% (6/805), which is in accordance with results of most studies evaluating the choice of CALND after SLNB [3][4][5][6][7][8][9][10][11][12][13][14]. After the 6th year of follow-up, axillary recurrence prevalence was apparent, at a rate of 1.7% (95% CI 0.2-3.1%).…”

“…The linear correlation between tumor size and the number of axillary metastatic nodes may justify the increased recurrence risk in women with large tumors [39]. Factors associated with undifferentiated tumors and their greater aggressiveness, such as the absence of hormone receptor expression and the high nuclear grade, may also increase the risk of regional nodal failure after SLNB [11,13,21], but our data confirm only the high nuclear grade as a recurrence risk factor. Important microhistological patterns with a possible predictive role in recurrence include peritumoral lymphovascular invasion, which represents a sign of progression in the metastatic process [33,40], and comedo-like necrosis, which is predictive of an unfavorable prognosis with aggressive biological behavior in node-negative invasive breast carcinoma [41] Controversy remains over the role of tumor multifocality as a recurrence risk factor, although the literature suggests the feasibility of SLNB even in the presence of multiple tumor foci [42].…”

Sentinel lymph node biopsy of the internal mammary chain in breast cancer

“…Sentinel lymph node (SLN) biopsy is a standard procedure for axillary assessment of patients presenting with clinically node-negative early breast cancer [1–4]. Depending on the technique of injecting the nanocolloid and the site of the tumor, extra axillary lymph drainage to the internal mammary chain (IMC) is found in up to 30 % of breast cancer patients [5–7].…”

Which Hottest Nodes Can Predict Sentinel Lymph Node Metastasis in Breast Cancer?

“…In one series, for instance, the highest number was 16, which prolongs the procedure and makes the surgeon wonder how many additional nodes should be removed [9,10]. In radioguided SLNB, any node with radioactivity above background level, and detectable by a g probe, is considered an SLN, irrespective of its count level, to ensure the identification of positive SLNs in all patients [1,9,11]. In our experience, the number of radioactive SLNs harvested from g-probe-guided SLNB, however, different from case to case, was greater than one in most cases, and over 50% of our patients had more than three SLNs.…”

“…Multiple SLNs were frequently encountered; the median number of SLNs harvested from SLNB was 4 (range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Pathologic sectioning of SLNs revealed metastasis in 87 patients (22%).…”