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

Abstract

Introduction: Sentinel lymph node biopsy (SLNB) is a precise procedure for lymphatic staging in early breast cancer. In a valid SLNB procedure, axillary lymph node dissection (ALND) can be omitted in nodenegative cases without compromising patient safety. In this study, detection rate, accuracy and false negative rate of SLNB for breast cancer was evaluated in a setting with simple modified conventional pathology facilities without any serial sectioning or immunohistochemistry. Material and Method: Patients with confirmed breast cancer were enrolled in the study. SLNB and ALND were performed in all cases. Lymph node metastasis was evaluated in SLN and in nodes removed by ALND to determine the false negative rate. Pathologic assessment was carried out only by modified conventional technique with only 3 sections. Detection rate was determined either by lymphoscintigraphy or during surgery. Results: 78 patients with 79 breast units were evaluated. SLN was detected in 75 of 79 cases (95%) in lymphoscintigraphy and 76 of 79 cases (96%) during surgery. SLN metastases was detected in 30 of 75 (40%) cases either in SLNB and ALND groups. Accuracy of SLNB method for detecting LN metastases was 92%. False negative rate was 3 of 30 of positive cases: 10%. In 7 of 10 cases with axillary lymphadenopathy, LN metastastates was detected. Conclusion: SLNB is recommended for patients with various tumor sizes without palpable lymph nodes. In modified conventional pathologic examination of SLNs, at least macrometastases and some micrometastases could be detected similar to ALND. Consequently, ALND could be omitted in node-negative cases with removal of all palpable LNs. We conclude that SLNB, as one of the most important developments in breast cancer surgery, could be expanded even in areas without sophisticated pathology facilities.Keywords: Breast neoplasm -lymphatic metastasis -lymph node dissection -sentinel lymph node biopsy

A combined nomogram model to preoperatively predict positive sentinel lymph biopsy for breast cancer in Iranian population

“…[ 3 ] Conventionally, ALND is used to determine the rate of lymph nodes involvement, but today, SLNB is recognized as a standard, selective, and noncomplicated method. [ 4 5 ] Following a histochemical assessment, patients with a negative SLNB response may not need an ALND. However, there is still a slight chance of NSLN engagement before an SLNB conflict, and surgeons may need an algorithm that measures the risk of NSLN involvement.…”

“…Considering the possibility of false-negative results in SLNB, it is essential to identify those patients more vulnerable to NSLN and to avoid localized relapses caused by positive lymph nodes behind a precursor missed in the scrutiny. [ 4 ] To identify these factors and tools in order to determine the probability of metastasis in nonguarded glands, some medical centers, such as the MD Anderson Cancer Center, have designed a nomogram that predicts the probability of positive NSLN in the case of metastasis in SLNB. Precision medicine is a therapeutic model that personalizes the health-care process by providing medical decisions, exercises, or pharmaceutical products for each individual patient.…”