title: Impact of non-axillary sentinel node biopsy on staging and treatment of breast cancer patients.
abstract: The purpose of this study was to evaluate the occurrence of lymphatic drainage to non-axillary sentinel nodes and to determine the implications of this phenomenon. A total of 549 breast cancer patients underwent lymphoscintigraphy after intratumoural injection of (99m)Tc-nanocolloid. The sentinel node was intraoperatively identified with the aid of intratumoural administered patent blue dye and a gamma-ray detection probe. Histopathological examination of sentinel nodes included step-sectioning at six levels and immunohistochemical staining. A sentinel node outside level I or II of the axilla was found in 149 patients (27%): internal mammary sentinel nodes in 86 patients, other non-axillary sentinel nodes in 44 and both internal mammary and other non-axillary sentinel nodes in nineteen patients. The intra-operative identification rate was 80%. Internal mammary metastases were found in seventeen patients and metastases in other non-axillary sentinel nodes in ten patients. Staging improved in 13% of patients with non-axillary sentinel lymph nodes and their treatment strategy was changed in 17%. A small proportion of clinically node negative breast cancer patients can be staged more precisely by biopsy of sentinel nodes outside level I and II of the axilla, resulting in additional decision criteria for postoperative regional or systemic therapy.
authors.affiliation: Department of Surgery, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. p_tanis@hotmail.com
authors.forename: P J
authors.initials: PJ
authors.lastname: Tanis
authors.forename: O E
authors.initials: OE
authors.lastname: Nieweg
authors.forename: R A
authors.initials: RA
authors.lastname: Valdés Olmos
authors.forename: J L
authors.initials: JL
authors.lastname: Peterse
authors.forename: E J Th
authors.initials: EJ
authors.lastname: Rutgers
authors.forename: C A
authors.initials: CA
authors.lastname: Hoefnagel
authors.forename: B B R
authors.initials: BB
authors.lastname: Kroon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000175:diagnosis*; D009367:Neoplasm Staging / Q000379:methods*; D011379:Prognosis; D021701:Sentinel Lymph Node Biopsy; D016896:Treatment Outcome