title: Use of the dye-guided sentinel lymph node biopsy method alone for breast cancer metastasis to avoid unnecessary axillary lymph node dissection.
abstract: For sentinel lymph node biopsy (SLNB), a combination of dye-guided and γ-probe-guided methods is the most commonly used technique. However, the number of institutes in which the γ-probe-guided method is able to be performed is limited, since special equipment is required for the method. In this study, SLNB with the dye-guided method alone was evaluated, and the clinicopathological characteristics were analyzed to identify any factors that were predictive of whether the follow-up axillary lymph node dissection (ALND) was able to be omitted. A total of 374 patients who underwent SLNB between 1999 and 2009 were studied. The SLN identification rate was analyzed, in addition to the false-positive and false-negative rates and the correlation between the clinicopathological characteristics and axillary lymph node metastases. The SLN was identified in 96.8% of cases, and, out of the patients who had SLN metastasis, 63.0% did not exhibit metastasis elsewhere. The sensitivity was 96.4% and the specificity was 100%. The false-negative rate was 3.6%. Univariate analyses revealed significant differences in the lymph vessel invasion (ly) status, nuclear grade (NG), maximum tumor size and the percentage of the area occupied by the tumor cells in the SLN (SLN occupation ratio) between the patients with and without non-SLN metastasis, indicating that these factors may be predictive of axillary lymph node metastasis. Multivariate analysis revealed that ly status was an independent risk factor for non-SLN metastasis. In conclusion, SLN with the dye-guided method alone provided a high detection rate. The study identified a predictive factor for axillary lymph node metastasis that may improve the patients' quality of life.
authors.affiliation: First Department of Surgery, Sapporo Medical University, Sapporo, Hokkaido 060-8543, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Takamaru
authors.affiliation: First Department of Surgery, Sapporo Medical University, Sapporo, Hokkaido 060-8543, Japan.
authors.forename: Goro
authors.initials: G
authors.lastname: Kutomi
authors.affiliation: First Department of Surgery, Sapporo Medical University, Sapporo, Hokkaido 060-8543, Japan.
authors.forename: Fukino
authors.initials: F
authors.lastname: Satomi
authors.affiliation: First Department of Surgery, Sapporo Medical University, Sapporo, Hokkaido 060-8543, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shima
authors.affiliation: First Department of Surgery, Sapporo Medical University, Sapporo, Hokkaido 060-8543, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Ohno
authors.affiliation: First Department of Surgery, Sapporo Medical University, Sapporo, Hokkaido 060-8543, Japan.
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Kameshima
authors.affiliation: First Department of Surgery, Sapporo Medical University, Sapporo, Hokkaido 060-8543, Japan.
authors.forename: Yasuyo
authors.initials: Y
authors.lastname: Suzuki
authors.affiliation: First Department of Surgery, Sapporo Medical University, Sapporo, Hokkaido 060-8543, Japan.
authors.forename: Tousei
authors.initials: T
authors.lastname: Ohmura
authors.affiliation: First Department of Internal Medicine, Sapporo Medical University, Sapporo, Hokkaido 060-8543, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takamaru
authors.affiliation: Department of Public Health, Sapporo Medical University, Sapporo, Hokkaido 060-8556, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Nojima
authors.affiliation: Department of Public Health, Sapporo Medical University, Sapporo, Hokkaido 060-8556, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Mori
authors.affiliation: First Department of Surgery, Sapporo Medical University, Sapporo, Hokkaido 060-8543, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Hirata
keywords: axillary lymph node dissection; breast cancer; dye-guided method; prediction of lymph node metastasis; sentinel lymph node biopsy