title: Sentinel lymph node biopsy in patients with multifocal breast cancer.
abstract: BACKGROUND
  Multifocal or multicentric breast cancer has been suggested as a contraindication for sentinel node biopsy (SNB). However, recent studies have demonstrated that all quadrants of the breast drain through common afferent channels to a common axillary sentinel node. This should mean that the presence of multifocal tumour should not affect the lymphatic drainage. The purpose of this study was to evaluate the feasibility and accuracy of SNB in patients with multifocal breast cancer using a peritumoural injection technique for sentinel lymph node (SN) mapping.
  
  
  METHODS
  In the ALMANAC multicentre trial validation phase, we took SNB samples from 842 patients with node negative, invasive breast cancer with use of a blue dye and radiolabelled colloid mapping technique at the peritumoural injection site. All patients underwent standard axillary treatment after SNB. Seventy-five of the 842 patients had multifocal lesions on final histopathologic examination. The following analysis is focused on patients with multifocal lesions.
  
  
  RESULTS
  A mean number of 2.4 SNs were identified in 71 of 75 patients (identification rate: 94.7%). Thirty-one patients had a positive SN, 40 a negative SN. Standard axillary treatment confirmed the SN to be negative in 37 of 40 patients, whereas three patients revealed positive non-sentinel lymph nodes (false-negative rate: 8.8%). Overall SN biopsy accurately predicted axillary lymph node status in 68 of 71 patients (95.8%).
  
  
  CONCLUSIONS
  SNB accurately staged the axilla in multifocal breast cancer and may become an alternative to complete axillary lymph node dissection in node negative patients with multifocal breast cancer.
authors.affiliation: Department of Surgery, University of Wales College of Medicine, Cardiff CF14 4XN, UK.
authors.forename: A
authors.initials: A
authors.lastname: Goyal
authors.forename: R G
authors.initials: RG
authors.lastname: Newcombe
authors.forename: R E
authors.initials: RE
authors.lastname: Mansel
authors.forename: U
authors.initials: U
authors.lastname: Chetty
authors.forename: P
authors.initials: P
authors.lastname: Ell
authors.forename: L
authors.initials: L
authors.lastname: Fallowfield
authors.forename: M
authors.initials: M
authors.lastname: Kissin
authors.forename: M
authors.initials: M
authors.lastname: Sibbering
mesh_terms: D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis* / Q000473:pathology; D018275:Carcinoma, Lobular / Q000175:diagnosis* / Q000473:pathology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D006113:United Kingdom / Q000453:epidemiology; D016387:Women's Health