title: Optimal sentinel node examination and a new strategy for axillary control in breast cancer.
abstract: The sentinel lymph nodes (SLNs) have been reported to reflect the other nodal status in breast cancer, and it is thought that axillary dissection can be avoided in SLN-negative patients, whereas an additional axillary dissection must be performed for SLN-positive patients. To avoid any unnecessary dissection, non-SLN-negative patients should be distinguished among SLN-positive patients. In this study, an optimal histological examination of SLNs was investigated for a precise indication of additional axillary clearance. A modified radical mastectomy with an axillary dissection was performed for 61 patients. Technetium-labeled tin colloids were used to identify the SLNs. In all lymph nodes that were diagnosed as negative at one section by hematoxylin and eosin (H&E) examination, another additional slice was produced for each lymph node. We evaluated how minute areas of cancer in the SLNs can indicate the non-SLNs to be negative. Among 1,092 lymph nodes previously diagnosed by H&E examination as negative at one section, 3 nodes were revealed to be positive in 46 SLNs (6.52%), whereas in additional slices, only 3 nodes out of 1,046 non-SLNs were positive (0.29%). The mean ratio of the cancer cell area to the whole area of SLN on the slice was 15.6% (10-18%) in 12 non-SLN-negative patients and 45.6% (30-83%) in 16 non-SLN-positive patients. It is possible that additional axillary clearance is not needed for patients with a cancer area of less than approximately 20% in the SLN slice, based on an H&E staining evaluation of two slices. SLNs identified with radiolabeled tin colloids could reflect the other nodal status in breast cancer. There is a possibility that additional axillary clearance is not needed for patients with a cancer area of less than approximately 20% in the SLN slice.
authors.affiliation: Department of Surgery I, National Defense Medical College, Saitama, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Ishikawa
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Sato
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Mochizuki
mesh_terms: D001365:Axilla; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D018567:Breast Neoplasms, Male / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D021701:Sentinel Lymph Node Biopsy / Q000592:standards*; D017556:Technetium Compounds; D017971:Tin Compounds
chemical_list: D017556:Technetium Compounds; D017971:Tin Compounds; C033493:technetium Tc 99m tin colloid