Optimal use of sentinel lymph node biopsy versus axillary lymph node dissection in patients with breast carcinoma: a decision analysis.
BACKGROUND
There are no data available from randomized controlled trials that compare the efficacy of sentinel lymph node (SLN) biopsy with Level I/II axillary lymph node dissection (ALND) in patients with breast carcinoma. We performed a formal decision analysis to determine whether SLN biopsy is appropriate, compared with ALND, for patients with T1, T2, and T3 tumors and to quantify the relative value of these two procedures in the management of patients with breast carcinoma.


METHODS
All clinically relevant outcomes were modeled for both SLN biopsy and ALND. The probabilities of complications and outcomes were derived using data from the University of Louisville Breast Cancer Sentinel Lymph Node Study and from extensive review of previous studies. Utilities were assigned by the authors, incorporating values from the literature whenever possible.


RESULTS
The expected utility of SLN biopsy was higher than the expected utility for ALND for T1 and T2 tumors that were 4.0 cm or smaller. There was no clear preference for either procedure with tumors that were larger than 4.0 cm. The T1 and T2 results were robust to sensitivity analysis.


CONCLUSIONS
The results of this decision analysis suggest that SLN biopsy is preferred over ALND for patients with breast tumors that are 4.0 cm or smaller. Patients should be aware of the potential for false-negative results in SLN biopsy, but this risk is outweighed by the decreased morbidity associated with the procedure itself.
Wong
Sandra L
SL
Division of Surgical Oncology, Department of Surgery, J. Graham Brown Cancer Center, University of Louisville, 529 S. Jackson Street No. 318, Louisville, KY 40202, USA.
Abell
Troy D
TD
Chao
Celia
C
Edwards
Michael J
MJ
McMasters
Kelly M
KM
D001365:Axilla; D001706:Biopsy / Q000379:methods / Q000592:standards; D001943:Breast Neoplasms / Q000473:pathology*; D003657:Decision Making; D003663:Decision Trees; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000175:diagnosis; D009367:Neoplasm Staging; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D012984:Software