title: Value of sentinel lymph node biopsy in breast cancer surgery with simple pathology facilities--an Iranian local experience with a review of potential causes of false negative results.
abstract: BACKGROUND
  Sentinel lymph node biopsy (SLNB) is a precise procedure for lymphatic staging in early breast cancer. In a valid SLNB procedure, axillary lymph node dissection (ALND) can be omitted in node- negative cases without compromising patient safety. In this study, detection rate, accuracy and false negative rate of SLNB for breast cancer was evaluated in a setting with simple modified conventional pathology facilities without any serial sectioning or immunohistochemistry.
  
  
  METHODS
  Patients with confirmed breast cancer were enrolled in the study. SLNB and ALND were performed in all cases. Lymph node metastasis was evaluated in SLN and in nodes removed by ALND to determine the false negative rate. Pathologic assessment was carried out only by modified conventional technique with only 3 sections. Detection rate was determined either by lymphoscintigraphy or during surgery.
  
  
  RESULTS
  78 patients with 79 breast units were evaluated. SLN was detected in 75 of 79 cases (95%) in lymphoscintigraphy and 76 of 79 cases (96%) during surgery. SLN metastases was detected in 30 of 75 (40%) cases either in SLNB and ALND groups. Accuracy of SLNB method for detecting LN metastases was 92%. False negative rate was 3 of 30 of positive cases: 10%. In 7 of 10 cases with axillary lymphadenopathy, LN metastastates was detected.
  
  
  CONCLUSIONS
  SLNB is recommended for patients with various tumor sizes without palpable lymph nodes. In modified conventional pathologic examination of SLNs, at least macrometastases and some micrometastases could be detected similar to ALND. Consequently, ALND could be omitted in node-negative cases with removal of all palpable LNs. We conclude that SLNB, as one of the most important developments in breast cancer surgery, could be expanded even in areas without sophisticated pathology facilities.
authors: Cancer Research Center, Shohadae Tajrish Hospital, Nuclear Medicine Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors: Mahasti
authors: M
authors: Amoui
authors: Mohammad Esmail
authors: ME
authors: Akbari
authors: Araam
authors: A
authors: Tajeddini
authors: Nahid
authors: N
authors: Nafisi
authors: Ghasem
authors: G
authors: Raziei
authors: Seyed Mahdi
authors: SM
authors: Modares
authors: Mohammad
authors: M
authors: Hashemi
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D002278:Carcinoma in Situ / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000473:pathology* / Q000601:surgery; D018275:Carcinoma, Lobular / Q000473:pathology* / Q000601:surgery; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007492:Iran; D008206:Lymphatic Diseases; D008207:Lymphatic Metastasis; D061305:Lymphoscintigraphy; D008408:Mastectomy; D008875:Middle Aged; D011379:Prognosis; D021701:Sentinel Lymph Node Biopsy