title: Are 3 sentinel nodes sufficient?
abstract: OBJECTIVE
  It has recently been proposed that only 3 sentinel lymph nodes (SLNs) are required for an adequate SLN biopsy. Others have advocated removing all nodes that are blue, hot, at the end of a blue lymphatic channel, or palpably suspicious or that have radioactive counts of 10% or greater of the most radioactive SLN. Our objective was to determine the false-negative rate (FNR) associated with limiting SLN biopsy to 3 nodes.
  
  
  METHODS
  Multicenter prospective study.
  
  
  METHODS
  Both academic and private practice.
  
  
  METHODS
  A total of 4131 patients underwent SLN biopsy followed by completion axillary node dissection.
  
  
  METHODS
  The FNR associated with 3-node SLN biopsy.
  
  
  RESULTS
  Of the 4131 patients in this study, an SLN was identified in 3882 (94.0%). The median number of SLNs identified was 2; more than 3 SLNs were removed in 738 patients (17.9%). Of the patients in whom a SLN was identified, 1358 (35.0%) were node positive. The overall FNR in this study was 7.7%. In 89.7% of node-positive patients, a positive SLN was found in the first 3 SLNs removed. If SLN biopsy had been limited to the first 3 nodes, the FNR would be 10.3% (P = .005 compared with removing >3 SLNs). The FNR increased with the strategy of limiting SLN biopsy to fewer SLNs (P<.001).
  
  
  CONCLUSIONS
  Removing only 3 SLNs cannot be recommended, because it is associated with a substantially increased FNR.
authors.affiliation: Department of Surgery, University of Louisville, Louisville, KY, USA. anees.chagpar@nortonhealthcare.org
authors.forename: Anees B
authors.initials: AB
authors.lastname: Chagpar
authors.forename: Charles R
authors.initials: CR
authors.lastname: Scoggins
authors.forename: Robert C G
authors.initials: RC
authors.lastname: Martin
authors.forename: David J
authors.initials: DJ
authors.lastname: Carlson
authors.forename: Alison L
authors.initials: AL
authors.lastname: Laidley
authors.forename: Souzan E
authors.initials: SE
authors.lastname: El-Eid
authors.forename: Terre Q
authors.initials: TQ
authors.lastname: McGlothin
authors.forename: Kelly M
authors.initials: KM
authors.lastname: McMasters
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000473:pathology* / Q000601:surgery; D018275:Carcinoma, Lobular / Q000473:pathology* / Q000601:surgery; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*