title: Sentinel lymph node biopsy is associated with improved survival compared to level I & II axillary lymph node dissection in node negative breast cancer patients.
abstract: OBJECTIVE
  The few long-term follow-up data for sentinel lymph node (SLN) negative breast cancer patients demonstrate a 5-year disease-free survival of 96-98%. It remains to be elucidated whether the more accurate SLN staging defines a more selective node negative patient group and whether this is associated with better overall and disease-free survival compared with level I & II axillary lymph node dissection (ALND).
  
  
  METHODS
  Three-hundred and fifty-five consecutive node negative patients with early stage breast cancer (pT1 and pT2< or =3 cm, pN0/pN(SN)0) were assessed from our prospective database. Patients underwent either ALND (n=178) in 1990-1997 or SLN biopsy (n=177) in 1998-2004. All SLN were examined by step sectioning, stained with H&E and immunohistochemistry. Lymph nodes from ALND specimens were examined by standard H&E only. Neither immunohistochemistry nor step sections were performed in the analysis of ALND specimen.
  
  
  RESULTS
  The median follow-up was 49 months in the SLN and 133 months in the ALND group. Patients in the SLN group had a significantly better disease-free (p=0.008) and overall survival (p=0.034). After adjusting for other prognostic factors in Cox proportional hazard regression analysis, SLN procedure was an independent predictor for improved disease-free (HR: 0.28, 95% CI: 0.10-0.73, p=0.009) and overall survival (HR: 0.34, 95% CI: 0.14-0.84, p=0.019).
  
  
  CONCLUSIONS
  This is the first prospective analysis providing evidence that early stage breast cancer patients with a negative SLN have an improved disease-free and overall survival compared with node negative ALND patients. This is most likely due to a more accurate axillary staging in the SLN group.
authors.affiliation: Division General Surgery, University Hospital Basel, Basel, Switzerland.
authors.forename: I
authors.initials: I
authors.lastname: Langer
authors.forename: U
authors.initials: U
authors.lastname: Guller
authors.forename: S F
authors.initials: SF
authors.lastname: Hsu-Schmitz
authors.forename: A
authors.initials: A
authors.lastname: Ladewig
authors.forename: C T
authors.initials: CT
authors.lastname: Viehl
authors.forename: H
authors.initials: H
authors.lastname: Moch
authors.forename: E
authors.initials: E
authors.lastname: Wight
authors.forename: F
authors.initials: F
authors.lastname: Harder
authors.forename: D
authors.initials: D
authors.lastname: Oertli
authors.forename: M
authors.initials: M
authors.lastname: Zuber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D021701:Sentinel Lymph Node Biopsy; D016019:Survival Analysis