title: Is the sentinel lymph node pathology protocol in breast cancer patients associated with the risk of regional recurrence?
abstract: BACKGROUND
  Internationally, there is no consensus on the pathology protocol to be used to examine the sentinel lymph node (SN) in breast cancer patients. Previously, we reported that ultra-staging led to more axillary lymph node dissections (ALND). The question was, whether ultra-staging is effective in reducing the risk of regional relapse.
  
  
  METHODS
  From January 2002 to July 2003, 541 patients from 4 hospitals were prospectively registered when they underwent a SN biopsy. In hospitals A, B, and C, 3 levels of the SN were examined pathologically, whereas in hospital D at least 7 additional levels were examined. Patients with a positive SN, including isolated tumor cells, underwent an ALND. This analysis focuses on the 341 patients with a negative SN. Primary endpoint was 5-year regional recurrence rate.
  
  
  RESULTS
  In hospital D 34% of the patients had a negative SN as compared to 71% in hospitals A, B, and C combined (p < 0.001). At 5 years follow-up, 9 (2.6%) patients had developed a regional lymph node relapse. In hospital D none of the patients had a regional recurrence, as compared to 9 (2.9%) cases of recurrence in hospitals A, B, and C.
  
  
  CONCLUSIONS
  The less intensified SN pathology protocol appeared to be associated with a slightly increased risk of regional recurrence. The absolute risk was still less than 3%, and does not seem to justify the intensified SN pathology protocol of hospital D.
authors: Department of Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors: M J
authors: MJ
authors: Bolster
authors: M J
authors: MJ
authors: Pepels
authors: C A P
authors: CA
authors: Wauters
authors: R F M
authors: RF
authors: Schapers
authors: J W R
authors: JW
authors: Meijer
authors: L J A
authors: LJ
authors: Strobbe
authors: C L H
authors: CL
authors: van Berlo
authors: J H G
authors: JH
authors: Klinkenbijl
authors: T
authors: T
authors: Wobbes
authors: A C
authors: AC
authors: Voogd
authors: P
authors: P
authors: Bult
authors: V C G
authors: VC
authors: Tjan-Heijnen
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis / Q000473:pathology*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011446:Prospective Studies; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy; D015996:Survival Rate