title: Clinical and histopathological factors affecting failed sentinel node localization in axillary staging for breast cancer.
abstract: BACKGROUND
  Sentinel lymph node biopsy (SLNB) has become the standard of care in axillary staging of clinically node-negative breast cancer patients.
  
  
  OBJECTIVE
  To analyze reasons for failure of SLN localization by means of a multivariate analysis of clinical and histopathological factors.
  
  
  METHODS
  We performed a review of 164 consecutive breast cancer patients who underwent SLNB. A superficial injection technique was used.
  
  
  RESULTS
  9/164 patients failed to show nodes. In 7/9 patients no evidence of radioactivity or blue dye was observed. Age and nodal status were the only statistically significant factors (p < 0.05). For every unit increase in age there was a 9% reduced chance of failed SLN localization. Patients with negative nodal status have 90% reduced risk of failed sentinel node localization than patients with macro or extra capsular nodal invasion.
  
  
  CONCLUSIONS
  The results suggest that altered lymphatic dynamics secondary to tumour burden may play a role in failed sentinel node localization. We showed that in all failed localizations the radiocolloid persisted around the injection site, showing limited local diffusion only. While clinical and histopathological data may provide some clues as to why sentinel node localization fails, we further hypothesize that integrity of peri-areolar lymphatics is important for successful localization.
authors.affiliation: Breast Unit, Department of General Surgery, Sunderland Royal Hospital, Kayll Road, SR4 7TP Sunderland, United Kingdom. matei.dordea@nhs.net
authors.forename: Matei
authors.initials: M
authors.lastname: Dordea
authors.forename: Hugh
authors.initials: H
authors.lastname: Colvin
authors.forename: Phil
authors.initials: P
authors.lastname: Cox
authors.forename: Andrea
authors.initials: A
authors.lastname: Pujol Nicolas
authors.forename: Venkat
authors.initials: V
authors.lastname: Kanakala
authors.forename: Obi
authors.initials: O
authors.lastname: Iwuchukwu
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy