Axillary lymph node dissection can be avoided in women with breast cancer with intraoperative, false-negative sentinel lymph node biopsies.
BACKGROUND
It is currently unclear which patients with breast cancer with sentinel lymph node (SLN) metastases do not need axillary lymph node dissection (ALND).


METHODS
A cohort of 1,132 women who had unilateral invasive breast cancer with clinically negative nodes or nodes suspicious for metastasis, were intraoperatively diagnosed as having negative SLNs, and did not undergo an immediate ALND. Our intraoperative histological investigation uses H&E staining of a frozen section from a maximum cut surface of each SLN. Of these 1,132 women, 132 (11.7%) were postoperatively diagnosed as having positive SLNs, which classifies them as having an intraoperative, false-negative SLN biopsy (SLNB). Patient and tumor characteristics, treatment methods, and the prognoses of these patients were investigated and compared with the remaining 1,000 patients who were negative for SLNB.


RESULTS
Of the 132 patients with intraoperative, false-negative SLNB, none underwent a further ALND. With a median follow-up period of 58.1 months, none of these patients exhibited recurrence in the axillary nodes. Their recurrence-free survival rates were not statistically different from those of patients with negative SLNB.


CONCLUSIONS
ALND can be avoided in most patients with breast cancer with intraoperative, false-negative SLNB.
Takei
Hiroyuki
H
Saitama Cancer Center, Komuro Ina, Kita-Adachi, Japan. h-takei@cancer-c.pref.saitama.jp
Kurosumi
Masafumi
M
Yoshida
Takashi
T
Ishikawa
Yuko
Y
Hayashi
Yuji
Y
Ninomiya
Jun
J
Tozuka
Katsunori
K
Oba
Hanako
H
Inoue
Kenichi
K
Nagai
Shigenori
S
Saito
Yoshihiro
Y
Kazumoto
Tomoko
T
Saitoh
Jun-ichi
J
Tabei
Toshio
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000556:secondary*; D015331:Cohort Studies; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D015996:Survival Rate; D016896:Treatment Outcome