title: Breast Cancer Patients Undergoing Sentinel Node Biopsy: Additional Axillary Tumor Burden as a Function of the Total Number of Excised Sentinel Nodes-A Multicenter Study.
abstract: BACKGROUND
  Recent studies have challenged the long-standing assumption that breast cancer prognosis is determined by lymph node regional status. We assessed locoregional relapse, distant metastases, and mortality alongside additional axillary disease in breast cancer patients undergoing sentinel node (SN) biopsy.
  
  
  METHODS
  This prospective study assessed 1070 women with clinical T1-T2 invasive breast cancer with negative clinical/ultrasound axillae.
  
  
  RESULTS
  A total of 25.1% of patients had positive SN biopsy findings, of whom 69.2% had only 1 involved SN. The rate of axillary recurrence was 0.7%, with no significant differences found between patients with positive or negative SN (0.6% vs. 1.1%). There were also no significant differences in the rate of distant metastases or breast cancer-specific mortality. If we had applied the Z0011 trial suggestions, residual axillary disease would have reached 16.2%: 13.5% in patients over 50% and 21.3% in patients under 50. The rate of residual axillary disease would have been 25.2% in patients with only 1 SN (20.2% in patients over 50% and 38.2% in patients under 50). In patients with 2 SN, residual disease would have ranged from 12.0% in patients over 50% to 19.0% in patients under 50. From 3 SN on, residual disease seems negligible.
  
  
  CONCLUSIONS
  There were no significant differences in locoregional relapse, distant metastases, or mortality between patients with negative and positive SN. Patients with 3 or more SN have no additional axillary disease. In patients younger 50, one must be extremely cautious if the Z0011 suggestions are to be applied, especially if there is only 1 SN.
authors.affiliation: Breast Unit, Department of Gynecology, CTD, University Hospital Mútua de Terrassa, University of Barcelona, Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: García-Fernández
authors.affiliation: Department of Nursing, School of Health Science TecnoCampus Mataró-Maresme, Maresme, Spain.
authors.forename: Carol
authors.initials: C
authors.lastname: Chabrera
authors.affiliation: International University of Catalunya, Catalunya, Spain.
authors.forename: Marc
authors.initials: M
authors.lastname: García-Font
authors.affiliation: Research Unit, Research Foundation Mútua de Terrassa, University of Barcelona, Barcelona, Spain; Laboratory of Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain. Electronic address: nuria.gimenez@uab.cat.
authors.forename: Nuria
authors.initials: N
authors.lastname: Giménez
authors.affiliation: Breast Unit, Department of Gynecology, CTD, University Hospital Mútua de Terrassa, University of Barcelona, Barcelona, Spain.
authors.forename: Israel
authors.initials: I
authors.lastname: Barco
authors.affiliation: Breast Unit, Department of Gynecology, Hospital de Terrassa, Consorci Sanitari de Terrassa, Barcelona, Spain.
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Lain
authors.affiliation: Department of Hemato-oncology, University Hospital Mútua de Terrassa, University of Barcelona, Barcelona, Spain.
authors.forename: Sonia
authors.initials: S
authors.lastname: González
authors.affiliation: Breast Unit, Department of Gynecology, CTD, University Hospital Mútua de Terrassa, University of Barcelona, Barcelona, Spain.
authors.forename: Merce
authors.initials: M
authors.lastname: Torras
authors.affiliation: Department of Radiology, University Hospital Mútua de Terrassa, University of Barcelona, Barcelona, Spain.
authors.forename: Asumpta
authors.initials: A
authors.lastname: Reñe
authors.affiliation: Department of Pathology, University Hospital Mútua de Terrassa, University of Barcelona, Barcelona, Spain.
authors.forename: Clarissa
authors.initials: C
authors.lastname: González
authors.affiliation: Department of Surgery, University Hospital Mútua de Terrassa, University of Barcelona, Barcelona, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Veloso
authors.affiliation: Department of Gynecology, University Hospital Mútua de Terrassa, University of Barcelona, Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Pessarrodona
authors.affiliation: Nuclear Medicine Department, CTD, University Hospital Mútua de Terrassa, University of Barcelona, Barcelona, Spain.
authors.forename: Manel
authors.initials: M
authors.lastname: Fraile
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis / Q000473:pathology*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000401:mortality; D017410:Practice Guidelines as Topic; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy; D047368:Tumor Burden; D055815:Young Adult
keywords: Breast neoplasm; Mortality; Neoplasm metastasis; Recurrence; Sentinel lymph node biopsy; Survival