title: The effect of sentinel node tumor burden on non-sentinel node status and recurrence rates in breast cancer.
abstract: BACKGROUND
  Routine axillary lymph node dissection (ALND) after selective sentinel lymphadenectomy (SSL) in the treatment of breast cancer remains controversial. We sought to determine the need for routine ALND by exploring the relationship between sentinel lymph node (SLN) and non-SLN (NSLN) status. We also report our experience with disease relapse in the era of SSL and attempt to correlate this with SLN tumor burden.
  
  
  METHODS
  This was a retrospective study of 390 patients with invasive breast cancer treated at a single institution who underwent successful SSL from November 1997 to November 2002.
  
  
  RESULTS
  Of the 390 patients, 115 received both SSL and ALND. The percentage of additional positive NSLNs in the SLN-positive group (34.2%) was significantly higher than in the SLN-negative group (5.1%; P = .0004). The SLN macrometastasis group had a significantly higher rate of positive NSLNs (39.7%) compared with the SLN-negative group (5.1%; P = .0001). Sixteen patients developed recurrences during follow-up, including 6.1% of SLN-positive and 3.3% of SLN-negative patients. Among the SLN macrometastasis group, 8.7% had recurrence, compared with 2.2% of SLN micrometastases over a median follow-up period of 31.1 months. One regional failure developed out of 38 SLN-positive patients who did not undergo ALND.
  
  
  CONCLUSIONS
  ALND is recommended for patients with SLN macrometastasis because of a significantly higher incidence of positive NSLNs. Higher recurrence rates are also seen in these patients. However, the role of routine ALND in patients with a low SLN tumor burden remains to be further determined by prospective randomized trials.
authors.affiliation: Department of Surgery, University of California San Francisco Medical Center at Mount Zion, San Francisco, 94143-1674, USA.
authors.forename: Yang-Guo
authors.initials: YG
authors.lastname: Fan
authors.forename: Yah-Yuen
authors.initials: YY
authors.lastname: Tan
authors.forename: Chen-Teng
authors.initials: CT
authors.lastname: Wu
authors.forename: Patrick
authors.initials: P
authors.lastname: Treseler
authors.forename: Ying
authors.initials: Y
authors.lastname: Lu
authors.forename: Chung-Wei
authors.initials: CW
authors.lastname: Chan
authors.forename: Shelley
authors.initials: S
authors.lastname: Hwang
authors.forename: Cheryl
authors.initials: C
authors.lastname: Ewing
authors.forename: Laura
authors.initials: L
authors.lastname: Esserman
authors.forename: Eugene
authors.initials: E
authors.lastname: Morita
authors.forename: Stanley P L
authors.initials: SP
authors.lastname: Leong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology*; D018275:Carcinoma, Lobular / Q000473:pathology*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D016896:Treatment Outcome; D047368:Tumor Burden