Validation of axillary sentinel lymph node detection in the staging of early lobular invasive breast carcinoma: a prospective study.
BACKGROUND
Previous reports have shown that regional lymph node involvement in patients with early-stage breast carcinoma can be evaluated by resection of axillary sentinel lymph nodes (ASLN). Axillary lymphadenectomy may be unnecessary in the absence of ASLN involvement. In the current study, the authors compared the results of ASLN resection in patients with lobular invasive carcinoma (LIC) with the results from patients with ductal invasive carcinoma (DIC) in terms of detection rates and false-negative rates.


METHODS
For ASLN detection, technetium 99m sulfur-colloid and patent blue were injected around the tumor. Each patient underwent both ASLN resection and complete axillary lymphadenectomy. Detection rates and false-negative rates were evaluated in patients with LIC and in patients with DIC.


RESULTS
Two hundred forty-three patients with invasive, early-stage breast carcinoma were enrolled in the study (208 patients with DIC and 35 patients with LIC). The median patient age, pathologic tumor size, hormone receptor status, and rates of involved lymph nodes were equivalent for both groups. ASLN detection and false-negative rates did not differ for patients with LIC and patients with DIC.


CONCLUSIONS
The ASLN detection rate was not dependent on the pathologic type of invasive carcinoma. Pathologic examination of ASLN in patients with LIC and in patients with DIC predicted axillary lymph node status with the same predictive value in terms of lymph node metastasis. For patients with LIC, ASLN examination overestimated the rate of micrometastasis as diagnosed by immunohistochemical techniques. These results will require confirmation in larger studies.
Department of Oncological Surgery, René Gauducheau Cancer Center, Saint-Herblain, France. jm-classe@nantes.fnclcc.fr
Jean-Marc
JM
Classe
Delphine
D
Loussouarn
Loïc
L
Campion
Maryse
M
Fiche
Chantal
C
Curtet
François
F
Dravet
Raphaëlle
R
Pioud
Caroline
C
Rousseau
Isabelle
I
Resche
Christine
C
Sagan
D000368:Aged; D001365:Axilla; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000473:pathology*; D044584:Carcinoma, Ductal; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000556:secondary*; D018275:Carcinoma, Lobular / Q000473:pathology / Q000556:secondary*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy