title: The risk of non-sentinel metastases in primary breast cancer.
abstract: BACKGROUND
  Sentinel node biopsy (SNB) has been established as standard of surgical care in primary breast cancer. If the sentinel node (SN) is negative, axillary dissection (ALND) is not necessary, but if the SN is positive ALND is warranted. This analysis evaluated associated risk factors for non-sentinel metastases in the case of a positive SN.
  
  
  METHODS
  A retrospective analysis of all SNB performed between 10/1999 and 07/2005 was carried out.
  
  
  RESULTS
  A total of 406 patients were included: 214 patients (51%) had SNB with ALND while 197 patients (49%) had SNB only. In 41 of 109 nodal-positive patients, the SN was the only nodal metastasis. In the multivariate analysis, the number of positive SN and the presence of lymphatic vessel infiltration were significant risk factors for additional non-sentinel metastases (p = 0.05 and 0.047, respectively). The risk for non-sentinel metastases was 25.9% without and 59.2% with these risk factors, respectively.
  
  
  CONCLUSIONS
  If the SN is positive, ALND remains obligatory.
authors.affiliation: Department of Obstetrics and Gynaecology, Ludwig Maximilians University of Munich, Germany. ingo.bauerfeind@med.uni-muenchen.de
authors.forename: Ingo G
authors.initials: IG
authors.lastname: Bauerfeind
authors.forename: Steffen
authors.initials: S
authors.lastname: Kahlert
authors.forename: Isabelle
authors.initials: I
authors.lastname: Himsl
authors.forename: Yevgenia
authors.initials: Y
authors.lastname: Sorokina
authors.forename: Ina M
authors.initials: IM
authors.lastname: Ruehl
authors.forename: Annette
authors.initials: A
authors.lastname: Lebeau
authors.forename: Reiner
authors.initials: R
authors.lastname: Linke
authors.forename: Michael
authors.initials: M
authors.lastname: Untch
authors.forename: Klaus
authors.initials: K
authors.lastname: Friese
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy