Sentinel Lymph Node Biopsy After Initial Lumpectomy (SNAIL Study)—a Prospective Validation Study
- 5 Downloads
Tertiary oncology center clinicians are commonly faced with the problem of managing patients with a diagnosis of breast cancer made after lumpectomy in the Primary Health Care (PHC) setting. There are no studies or guidelines that address the further surgical management in this group of patients regarding sentinel lymph node biopsy (SLNB) and need for breast post-operative cavity excision. Prospective observational study was planned to evaluate the feasibility of SLNB and defining the need for definitive breast surgery in patients diagnosed with breast cancer after lumpectomy in PHC. The study was carried out from January 2015 to August 2017 in Tata Medical Center, India, approved by institutional review board (EC/TMC/36/14). Seventy patients who underwent lumpectomy with a definitive histological analysis of breast cancer were included in this study. Each patient had definitive breast surgery and SLNB using subareoral blue dye injection followed by validation axillary dissection. The identification rate (IR) for SLNB was 92% (64/70). The median number of SLNs removed was 2 (IQR 1, 3). There were 2 patients with false negative results resulting in false negative rate (FNR) of 11%. Overall, SLNB procedure has the sensitivity of 89%, NPV of 96%, and accuracy was 97%. Peri-areoral incision of initial surgery was associated with low IR (84%) and high FNR (33%). Final histopathology showed residual invasive cancer in 43% and ductal carcinoma in situ in 14% of patients. Among 21 patients where initial lumpectomy histopathology margin was free of cancer, residual malignancy was found in 57% of patients. Prior excision of lumps for breast cancer does not affect the accuracy of SLNB. Peri-areoral scar may be associated with high FNR and low IR, although further studies are needed to validate this statement. Definitive breast surgery is required for all patients, irrespective of initial lumpectomy histopathological margin status.
KeywordsBreast Cancer Sentinel lymph node biopsy
Compliance with Ethical Standards
Following approval by the institutional review board (EC/TMC/36/14), informed consent was taken from a consecutive series of patients suitable for inclusion, and participants were enrolled from January 2015 to August 2017.
Conflict of Interest
The authors declare that they have no conflict of interest.
- 4.Lyman GH, Temin S, Edge SB, Newman LA, Turner RR, Weaver DL, Benson AB 3rd, Bosserman LD, Burstein HJ, Cody H 3rd, Hayman J, Perkins CL, Podoloff DA, Giuliano AE, American Society of Clinical Oncology Clinical Practice (2014) Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 32:1365–1383CrossRefGoogle Scholar
- 12.Agrawal SK, Shenoy SS, Nalawade N, Datta SS, Roy S, Chatterjee S, Arun I, Ahmed R (2018) Quality indicators for sentinel lymph node biopsy in breast cancer: applicability and clinical relevance in a non-screened population. Indian J Surg Oncol 9(3):312–317. https://doi.org/10.1007/s13193-017-0695-5
- 14.Mansel RE, Fallowfield L, Kissin M, Goyal A, Newcombe RG, Dixon JM, Yiangou C, Horgan K, Bundred N, Monypenny I, England D, Sibbering M, Abdullah TI, Barr L, Chetty U, Sinnett DH, Fleissig A, Clarke D, Ell PJ (2006) Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC trial. J Natl Cancer Inst 98:599–609CrossRefGoogle Scholar
- 15.Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Ashikaga T, Weaver DL, Miller BJ, Jalovec LM, Frazier TG, Noyes RD, Robidoux A, Scarth HM, Mammolito DM, McCready D, Mamounas EP, Costantino JP, Wolmark N, National Surgical Adjuvant Breast and Bowel Project (2007) Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial. Lancet Oncol 8:881–888CrossRefGoogle Scholar
- 18.Canavese G, Catturich A, Vecchio C, Tomei D, Gipponi M, Villa G, Carli F, Bruzzi P, Dozin B (2009) Sentinel node biopsy compared with complete axillary dissection for staging early breast cancer with clinically negative lymph nodes: results of randomized trial. Ann Oncol 20:1001–1007CrossRefGoogle Scholar
- 19.Veronesi U, Viale G, Paganelli G, Zurrida S, Luini A, Galimberti V, Veronesi P, Intra M, Maisonneuve P, Zucca F, Gatti G, Mazzarol G, de Cicco C, Vezzoli D (2010) Sentinel lymph node biopsy in breast cancer: ten-year results of a randomized controlled study. Ann Surg 251:595–600CrossRefGoogle Scholar
- 20.Renaudeau C, Lefebvre-Lacoeuille C, Campion L, Dravet F, Descamps P, Ferron G, Houvenaeghel G, Giard S, Tunon de Lara C, Dupré PF, Fritel X, Ngô C, Verhaeghe JL, Faure C, Mezzadri M, Damey C, Classe JM (2016) Evaluation of sentinel lymph node biopsy after previous breast surgery for breast cancer: GATA study. Breast 28:54–59CrossRefGoogle Scholar
- 22.Wong SL, Edwards MJ, Chao C, Tuttle TM, Noyes RD, Carlson DJ, Laidley AL, McGlothin TQ, Ley PB, Brown CM, Glaser RL, Pennington RE, Turk PS, Simpson D, McMasters KM, the University of Louisville Breast Cancer Study Group (2002) The effect of prior breast biopsy method and concurrent definitive breast procedure on success and accuracy of sentinel lymph node biopsy. Ann Surg Oncol 9:272–277CrossRefGoogle Scholar