title: A prospective study of the value of axillary node sampling in addition to sentinel lymph node biopsy in patients with breast cancer.
abstract: OBJECTIVE
  Limitations of sentinel lymph node biopsy (SLNB) include the occurrence of false negative (FN) results and the need to further treat SLNB positive axillae. The aims of this study were to: (1) compare the accuracy of SLNB alone to a combined SLNB and axillary sampling procedure (SLNB+AS). (2) evaluate if the additional AS could identify those SLNB positive cases with no further disease in the axilla.
  
  
  METHODS
  Sixty-seven combined SLNB+AS procedures were performed prospectively in 66 patients, followed by Level II axillary dissection. Additionally sampled nodes were recorded if they were clinically suspicious or not at intra-operative palpation.
  
  
  RESULTS
  The FN rate for SLNB alone was 14.3%, whilst that for SLNB+AS was reduced to 3.6%. However, the benefit of additional sampling was only seen in those cases with tumours >/=3 cm and clinically suspicious nodes (n=12). Of 12 cases with a positive SLN but negative AS, 4 (30%) were found to have disease elsewhere in the axilla.
  
  
  CONCLUSIONS
  SLNB is inaccurate in the presence of suspicious nodes found at operation and careful palpation and sampling of these nodes is recommended, especially with larger tumours. In SLNB positive patients, AS is unreliable in predicting those patients with no further disease in the axilla.
authors.affiliation: Department of Surgery, City Hospital, Dudley Road, B18 7QH, England, Birmingham, UK.
authors.forename: F J
authors.initials: FJ
authors.lastname: Hoar
authors.forename: P S
authors.initials: PS
authors.lastname: Stonelake
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy