Introduction of sentinel node biopsy and stage migration of breast cancer

Abstract

Aim: The purpose of this study was to examine in a large population based group of breast cancer patients treated in a regular care setting whether the introduction of the Sentinel Node Biopsy (SNB) led to detection of a higher percentage of patients with positive regional lymph nodes. Methods: The study includes 3665 early breast cancer patients, aged 30e85 years, diagnosed in the period 1997-2002 and registered at the Regional Cancer Registry of the Comprehensive Cancer Centre Middle Netherlands. During this period the SNB was introduced. The outcome of staging was compared for groups staged with or without SNB. A logistic regression model was used to adjust for age, calendar period and tumour size. Results: Overall a quarter of all patients over the period 1997e2002 underwent a SNB as method of lymphatic staging. The use of SNB clearly increased over time: from 2% in 1998 to 65% in 2002. The percentage node positive patients also rose significantly; before introduction of the SNB 30% of all patients were diagnosed with positive lymph nodes, and after SNB introduction this percentage was 40%. The increase is largely explained by the increase of patients diagnosed with only micrometastases. Adjustment did not change the results. Conclusion: In conclusion, introduction of the SNB in early breast cancer led to significant upstaging of breast cancer patients treated in a regular care setting, due to the detection of more micrometastases. Since the relevance of micrometastases for long term survival is not yet known, this upstaging potentially led to over treatment of patients. On the other side, for some patients axillary lymph node dissection was prevented by the SNB procedure, preventing comorbidity.

Stage migration due to introduction of the sentinel node procedure: a population-based study

“…Furthermore, we included patients diagnosed over a longer period of time and compared two periods before and after introduction of the SNB. Remarkably, despite the availability of a national guideline regarding SNB, our study showed a smaller increase in number of micrometastases than the report from the central part of The Netherlands [21]. The most likely explanation for this discrepancy is a difference in the thoroughness of the examination of the SN between pathology laboratories, with a varying number of sections and cutting intervals.…”

“…A recent study from the Comprehensive Cancer Centre Middle Netherlands showed that the percentage of patients diagnosed with positive lymph nodes increased from 30% in 1997 to 40% in 2002 [21]. This increase could be entirely explained by the increasing proportion of patients with micrometastatic disease, which rose from 1% to 10%.…”

Sentinel node micrometastases in breast cancer do not affect prognosis: a population-based study

“…Occult metastases or micrometastases were detected in 9-23% of originally Hematoxylin & Eosin node-negative cases [8]. Recent studies showed a 4.3-10% increase among patients diagnosed with micrometastatic disease in the sentinel node as well [9,10]. This increase led to stage migration after adjustment for the simultaneous, favorable trend in tumor size [9].…”

Value of Sentinel Lymph Node Biopsy in Breast Cancer Surgery with Simple Pathology Facilities -An Iranian Local Experience with a Review of Potential Causes of False Negative Results

“…Strength of SLNB technique over ALND is its careful and precise evaluation of few specimen by intensive methods as serial sectioning and ImmunoHistoChemistry (IHC) to detect more micrometastasis as well as isolated tumor cells (Lyman et al, 2005). Although detection of nodepositive patients considerably rises at least 10% after introduction of SLNB procedure (van der Heiden-van der Loo et al, 2006), however, importance of these cells and probable effect on outcome and treatment planning is a controversial issue (Cox et al, 2008;Langer et al, 2009;TruongLesperance, 2010)and requires to be answered in ongoing clinical trials as ACOSOG -Z0010 and IBCSG-23-01 (Giuliano et al, 2011;Galimberti, 2006).…”

“…So, many extensive histopathologic examination of SLN has been designed to identify micrometastases and isolated tumor cells and even molecular changes (Lyman et al, 2005). Some studies show that detection of metastasis by SLNB technique is better than ALND and percentage of node-positive patients considerably rises at least 10% after introduction of SLNB procedure (Lyman et al, 2005;Mansel et al, 2006;van der Heiden-van der Loo et al, 2006) and is largely explained by watchful lymphatic mapping.…”