title: [Sentinel lymph node negative breast cancer larger than 30 mm: is axillary lymph node dissection constantly necessary?].
abstract: Benefits provided by sentinel lymph node biopsy (SLNB) include improvement of pathologic examination and lower rate of sequels. The aim of this study was to assess the accuracy of this procedure in large tumors. From march 1999 and december 2003, 663 patients were operated for a breast cancer and underwent a SLNB. All patients with tumor larger than 30 mm and/or with involved SLNB underwent a complete axillary dissection (AD). One hundred and sixteen patients (17.5%) with a tumor larger than 30 mm underwent an AD. Identification rate of SLNB was 94% (109/116). Among the 43 cases with non metastatic SLNB, the AD was negative in 39 cases (90.7%). In four cases a palpable non sentinel lymph node discovered during the SLNB procedure was found to be involved. In one case the lymphoscintigraphy found only one lymph node with a very low fixation and an AD was performed because of low efficiency of the lymphoscintigraphy procedure. SLNB false negative rate was 1.4 % (1/72) among the 72 cases with lymph node involvement. AD was performed in 66 cases (60.5%) during the same operating time than the SLNB. AD showed a lymph node involvement in 30 cases (30/72, 41.7%): in 5 cases among 24 cases with microscopic disease (20.8%) and in 25 cases among 48 cases with macroscopic disease (52%). This series results suggest than AD could be avoided for negative SLNB tumors up to 50 mm at pathologic examination in patients with clinically-measured tumor smaller than 30 mm.
authors.affiliation: Départements de chirurgie, Institut Paoli-Calmettes, 232 bd Sainte-Marguerite, 13006 Marseille Cedex 9.
authors.forename: Gilles
authors.initials: G
authors.lastname: Houvenaeghel
authors.forename: Marc
authors.initials: M
authors.lastname: Martino
authors.forename: Max
authors.initials: M
authors.lastname: Buttarelli
authors.forename: Vincent
authors.initials: V
authors.lastname: Moutardier
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Charaffe Jaufret
authors.forename: Isabelle
authors.initials: I
authors.lastname: Rossi
authors.forename: Carole
authors.initials: C
authors.lastname: Tarpin
authors.forename: Agnès
authors.initials: A
authors.lastname: Tallet
authors.forename: Patrice
authors.initials: P
authors.lastname: Viens
authors.forename: Jocelyne
authors.initials: J
authors.lastname: Jacquemier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods / Q000706:statistics & numerical data*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D008875:Middle Aged; D011877:Radionuclide Imaging; D021701:Sentinel Lymph Node Biopsy; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*