title: The clinical relevance of positive sentinel nodes only versus positive nonsentinel lymph nodes in breast cancer patients.
abstract: BACKGROUND
  The purpose of this study was to determine the difference in clinical outcomes for patients with histologically positive sentinel lymph nodes (SLN+) compared with patients with histologically positive nonsentinel second echelon lymph nodes (NSLN+).
  
  
  METHODS
  Eight hundred thirteen node positive patients from a prospectively accrued database of 3200 patients who underwent sentinel node mapping were evaluated. In all, 506 of the 813 patients (62%) were SLN+ only and 307 of the 813 patients (38%) were SLN+ plus at least one NSLN+. Patients' overall survival and disease-free survival were obtained and statistical analyses performed comparing the two groups.
  
  
  RESULTS
  As the number of NSLN+ increased, there was a significant difference in disease-free survival (P = 0.001) and overall survival (P = 0.003) between those patients who had 0 to 4 NSLN+ and those who had 5 or more NSLN+. The SLN+ only patients did not show significant differences with respect to survival, based on the number of SLN+ (overall survival, disease-free survival; P = 0.742).
  
  
  CONCLUSIONS
  The survival (overall survival, disease-free survival) for patients with 3 or more SLN+ was not statistically different than for patients with 1 or 2 SLN+ (P = 0.742). However, an alteration of biologic behavior was observed when multiple NSLN+ contain metastatic breast cancer. Involvement of 5 or more NSLN+ portends a significantly (P = 0.001) worse prognosis, regardless of the number of SLN+.
authors.affiliation: Department of Surgery, H Lee Moffitt Cancer Center and Research Institute at the University of South Florida, 12902 Magnolia Dr, Suite 3157, Tampa, FL 33612, USA. coxce@moffitt.edu
authors.forename: Charles
authors.initials: C
authors.lastname: Cox
authors.forename: Elisabeth L
authors.initials: EL
authors.lastname: DuPont
authors.forename: Ben
authors.initials: B
authors.lastname: Furman
authors.forename: Nicholas
authors.initials: N
authors.lastname: Stowell
authors.forename: John
authors.initials: J
authors.lastname: Clark
authors.forename: Mark
authors.initials: M
authors.lastname: Ebert
authors.forename: Nils M
authors.initials: NM
authors.lastname: Diaz
authors.forename: Alan
authors.initials: A
authors.lastname: Cantor
mesh_terms: D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology*; D018572:Disease-Free Survival; D006801:Humans; D008207:Lymphatic Metastasis; D011379:Prognosis; D021701:Sentinel Lymph Node Biopsy; D015996:Survival Rate