title: Axillary lymph node dissection can be avoided in women with breast cancer with intraoperative, false-negative sentinel lymph node biopsies.
abstract: 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.
authors.affiliation: Saitama Cancer Center, Komuro Ina, Kita-Adachi, Japan. h-takei@cancer-c.pref.saitama.jp
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takei
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kurosumi
authors.forename: Takashi
authors.initials: T
authors.lastname: Yoshida
authors.forename: Yuko
authors.initials: Y
authors.lastname: Ishikawa
authors.forename: Yuji
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Jun
authors.initials: J
authors.lastname: Ninomiya
authors.forename: Katsunori
authors.initials: K
authors.lastname: Tozuka
authors.forename: Hanako
authors.initials: H
authors.lastname: Oba
authors.forename: Kenichi
authors.initials: K
authors.lastname: Inoue
authors.forename: Shigenori
authors.initials: S
authors.lastname: Nagai
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Saito
authors.forename: Tomoko
authors.initials: T
authors.lastname: Kazumoto
authors.forename: Jun-ichi
authors.initials: J
authors.lastname: Saitoh
authors.forename: Toshio
authors.initials: T
authors.lastname: Tabei
mesh_terms: 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