title: Improved false negative rate of axillary status using sentinel lymph node biopsy and ultrasound-suspicious lymph node sampling in patients with early breast cancer.
abstract: BACKGROUND
  The false negative rate of sentinel lymph node biopsy (SLNB) is 5-10%, and results in improper patient management. The study was to assess the value of ultrasound-suspicious axillary lymph node biopsy (USALNB) in patients with early breast cancer, and to compare SLNB combined with USALNB (SLNB + USALNB) with SLNB alone.
  
  
  METHODS
  From January 2010 to July 2013, 216 patients with early breast cancer were enrolled consecutively at the Department of Breast and Thyroid Surgery, Qianfoshan Hospital, Shandong University. All patients underwent wire localization of the suspicious node by color Doppler ultrasonography, followed by SLNB 2-3 hours later, suspicious node lymphadenectomy, and level ≥ II axillary dissection (as the gold standard). The predictive values of node status between SLNB + USALNB and SLNB alone were compared.
  
  
  RESULTS
  The success rate of SLNB was 99.1% (214/216). After axillary dissection, 71 patients were confirmed with axillary lymph node metastases by pathological examinations. Eight false negatives were observed using SLNB alone, resulting in sensitivity of 88.7%, specificity of 100%, false negative rate of 11.3%, and false positive rate of 0% in predicting the axillary node status. SLNB + USALNB resulted in sensitivity of 97.2%, specificity of 100%, false negative rate of 2.8%, and false positive rate of 0%. The false negative rate of SLNB + USALNB was significantly different from that of SLNB alone (P = 0.031).
  
  
  CONCLUSIONS
  SLNB + USALNB seems to be a low-risk procedure that might be useful in reducing the false negative rate of SLNB, improving the accuracy of axillary nodes evaluation in early breast cancer.
authors.affiliation: Department of Breast and Thyroid Surgery, Subsidiary Qianfoshan Hospital of Shandong Universityf, Jinan, 250014, Shandong Province, China. QYWYL2013@163.com.
authors.forename: Yulong
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Endoscopy, Subsidiary Qianfoshan Hospital of Shandong University, Jinan, 250014, Shandong Province, China. ddhyy918@126.com.
authors.forename: Haiyan
authors.initials: H
authors.lastname: Dong
authors.affiliation: Department of Health Management Center, Subsidiary Qianfoshan Hospital of Shandong University, Jinan, 250014, Shandong Province, China. 13791120978@163.com.
authors.forename: Hongyan
authors.initials: H
authors.lastname: Wu
authors.affiliation: Department of Ultrasound, Subsidiary Qianfoshan Hospital of Shandong University, Jinan, 250014, Shandong Province, China. violetgirl1979@163.com.
authors.forename: Li
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Breast and Thyroid Surgery, Subsidiary Qianfoshan Hospital of Shandong Universityf, Jinan, 250014, Shandong Province, China. yuankai168@163.com.
authors.forename: Kai
authors.initials: K
authors.lastname: Yuan
authors.affiliation: Department of Breast and Thyroid Surgery, Subsidiary Qianfoshan Hospital of Shandong Universityf, Jinan, 250014, Shandong Province, China. chq3606@163.com.
authors.forename: Hongqiang
authors.initials: H
authors.lastname: Chen
authors.affiliation: Department of Breast and Thyroid Surgery, Subsidiary Qianfoshan Hospital of Shandong Universityf, Jinan, 250014, Shandong Province, China. jmw881212@126.com.
authors.forename: Mingwen
authors.initials: M
authors.lastname: Jiao
authors.affiliation: Department of Breast and Thyroid Surgery, Subsidiary Qianfoshan Hospital of Shandong Universityf, Jinan, 250014, Shandong Province, China. frzmedsci@163.com.
authors.forename: Rongzhan
authors.initials: R
authors.lastname: Fu
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery; D015331:Cohort Studies; D042241:Early Diagnosis; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D021701:Sentinel Lymph Node Biopsy; D014463:Ultrasonography