title: Feasibility of sentinel lymph node biopsy in breast cancer patients clinically suspected of axillary lymph node metastasis on preoperative imaging.
abstract: BACKGROUND
  Generally, sentinel lymph node biopsy (SLNB) is performed in patients with clinically negative axillary lymph node (LN). This study was to assess imaging techniques in axillary LN staging and to evaluate the feasibility of SLNB in patients clinically suspected of axillary LN metastasis on preoperative imaging techniques (SI).
  
  
  METHODS
  A prospectively maintained database of 767 breast cancer patients enrolled between January 2006 and December 2009 was reviewed. All patients were offered preoperative breast ultrasound, magnetic resonance imaging, and positron emission tomography scanning. SI patients were regarded as those for whom preoperative imaging was "suspicious for axillary LN metastasis" and NSI as "non-suspicious for axillary LN metastasis" on preoperative imaging techniques. Patients were subgrouped by presence of SI and types of axillary operation, and analyzed.
  
  
  RESULTS
  For 323 patients who received SLNB, there was no statistically significant difference in axillary recurrence (P=0.119) between SI and NSI groups. There also was no significant difference in axillary recurrence between SLNB and axillary lymph node dissection (ALND) groups in 356 SI patients (P=0.420). The presence of axillary LN metastasis on preoperative imaging carried 82.1% sensitivity and 45.9% specificity for determining axillary LN metastasis on the final pathology.
  
  
  CONCLUSIONS
  SLNB in SI patents is safe and feasible. Complications might be avoided by not performing ALND. Therefore, we recommend SLNB, instead of a direct ALND, even in SI patients, for interpreting the exact nodal status and avoiding unnecessary morbidity by performing ALND.
authors.affiliation: Department of Surgery, Catholic University of Korea, College of Medicine, Seoul, Republic of Korea.
authors.forename: Hee Yong
authors.initials: HY
authors.lastname: Kwak
authors.forename: Byung Joo
authors.initials: BJ
authors.lastname: Chae
authors.forename: Ja Seong
authors.initials: JS
authors.lastname: Bae
authors.forename: Eun Jin
authors.initials: EJ
authors.lastname: Kim
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Chang
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Kim
authors.forename: Sang Seol
authors.initials: SS
authors.lastname: Jung
authors.forename: Byung Joo
authors.initials: BJ
authors.lastname: Song
mesh_terms: D001365:Axilla; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011379:Prognosis; D021701:Sentinel Lymph Node Biopsy; D015996:Survival Rate; D016217:Ultrasonography, Mammary