title: Characteristics of breast carcinoma cases with false-negative sentinel lymph nodes.
abstract: BACKGROUND
  In the past decade, sentinel lymph node biopsy (SLNB) has become standard for patients with early-stage clinically node-negative breast carcinoma (BC). Despite high overall surgical identification success rates with introduction of the dual-tracer techniques (dye and radiolabeled probe), false-negative rates remained unchanged in most recent meta-analyses.
  
  
  METHODS
  We analyzed cases with false-negative SLN biopsy results over a 12-year period in a single institution to evaluate their clinicopathologic characteristics. Sixty-three false-negative cases (3.1%) were found in 2043 successful SLN mapping procedures, all of which were followed by varying amounts of additional axillary sampling.
  
  
  RESULTS
  There was a higher proportion of invasive lobular carcinomas (ILCs; 23 cases [37%]) when compared with this lesion's overall reported frequency (5%-15%). The majority of invasive ductal carcinoma (IDC) cases (31 of 40) were poorly differentiated. In 80% of the ductal-type cases, 1 or more nonsentinel nodes (NSLNs) were completely or partially replaced by tumor, as opposed to less than half of such cases of the lobular type. Twenty-two cases had multiple positive NSLN metastases, which were significantly associated with larger tumor size (≥ 1.0 cm) and tumor replacement of NSLNs. Eighty-two percent of the cases with known hormone receptor status were positive for estrogen or progesterone receptors, or both.
  
  
  CONCLUSIONS
  False-negative SLN biopsy results were more often associated with a primary BC characterized by a lobular or poorly differentiated ductal histologic type or partial to complete replacement of NSLNs with tumor, or both.
authors.affiliation: Department of Pathology, University of Alabama at Birmingham (UAB), Birmingham, AL.
authors.forename: Shi
authors.initials: S
authors.lastname: Wei
authors.affiliation: Department of Pathology, Mount Sinai Medical Center, New York, NY.
authors.forename: Ira J
authors.initials: IJ
authors.lastname: Bleiweiss
authors.affiliation: Department of Pathology, Mount Sinai Medical Center, New York, NY.
authors.forename: Chandandeep
authors.initials: C
authors.lastname: Nagi
authors.affiliation: Department of Pathology, Mount Sinai Medical Center, New York, NY. Electronic address: shabnam.jaffer@mountsinai.org.
authors.forename: Shabnam
authors.initials: S
authors.lastname: Jaffer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000556:secondary* / Q000601:surgery; D018275:Carcinoma, Lobular / Q000556:secondary* / Q000601:surgery; D005188:False Negative Reactions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D021701:Sentinel Lymph Node Biopsy
keywords: Axillary lymph node dissection; Immunohistochemical analysis; Node-negative breast cancer; Sentinel lymph node biopsy