Pathology & Oncology Research

, Volume 13, Issue 1, pp 5–14 | Cite as

Sentinel lymph node biopsy in staging small (up to 15 mm) breast carcinomas. Results from a European multi-institutional study

  • Gábor Cserni
  • Simonetta Bianchi
  • Vania Vezzosi
  • Riccardo Arisio
  • Rita Bori
  • Johannes L. Peterse
  • Anna Sapino
  • Isabella Castellano
  • Maria Drijkoningen
  • Janina Kulka
  • Vincenzo Eusebi
  • Maria P. Foschini
  • Jean-Pierre Bellocq
  • Cristi Marin
  • Sten Thorstenson
  • Isabel Amendoeira
  • Angelika Reiner-Concin
  • Thomas Decker
  • Manuela Lacerda
  • Paulo Figueiredo
  • Gábor Fejes


Sentinel lymph node (SLN) biopsy has become the preferred method for the nodal staging of early breast cancer, but controversy exists regarding its universal use and consequences in small tumors. 2929 cases of breast carcinomas not larger than 15 mm and staged with SLN biopsy with or without axillary dissection were collected from the authors′ institutions. The pathology of the SLNs included multilevel hematoxylin and eosin (HE) staining. Cytokeratin immunohistochemistry (IHC) was commonly used for cases negative with HE staining. Variables influencing SLN involvement and non-SLN involvement were studied with logistic regression. Factors that influenced SLN involvement included tumor size, multifocality, grade and age. Small tumors up to 4 mm (including in situ and microinvasive carcinomas) seem to have SLN involvement in less than 10%. Non-SLN metastases were associated with tumor grade, the ratio of involved SLNs and SLN involvement type. Isolated tumor cells were not likely to be associated with further nodal load, whereas micrometastases had some subsets with low risk of non-SLN involvement and subsets with higher proportion of further nodal spread. In situ and microinvasive carcinomas have a very low risk of SLN involvement, therefore, these tumors might not need SLN biopsy for staging, and this may be the approach used for very small invasive carcinomas. If an SLN is involved, isolated tumor cells are rarely if ever associated with non-SLN metastases, and subsets of micrometastatic SLN involvement may be approached similarly. With macrometastases the risk of non-SLN involvement increases, and further axillary treatment should be generally indicated.

Key words

Sentinel lymph node non-sentinel lymph node breast cancer pT1 



axillary lymph node dissection


ductal carcinoma in situ


isolated tumor cells


lymphovascular invasion


sentinel lymph node


sentinel lymph node biopsy


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Copyright information

© Arányi Lajos Foundation 2007

Authors and Affiliations

  • Gábor Cserni
    • 1
  • Simonetta Bianchi
    • 2
  • Vania Vezzosi
    • 2
  • Riccardo Arisio
    • 3
  • Rita Bori
    • 1
  • Johannes L. Peterse
    • 4
  • Anna Sapino
    • 5
  • Isabella Castellano
    • 5
  • Maria Drijkoningen
    • 6
  • Janina Kulka
    • 7
  • Vincenzo Eusebi
    • 8
  • Maria P. Foschini
    • 8
  • Jean-Pierre Bellocq
    • 9
  • Cristi Marin
    • 9
  • Sten Thorstenson
    • 10
  • Isabel Amendoeira
    • 11
  • Angelika Reiner-Concin
    • 12
  • Thomas Decker
    • 13
  • Manuela Lacerda
    • 14
  • Paulo Figueiredo
    • 14
  • Gábor Fejes
    • 15
  1. 1.Department of PathologyBács-Kiskun County Teaching HospitalKecskemétHungary
  2. 2.Department of Human Pathology and OncologyUniversity of FlorenceFlorenceItaly
  3. 3.Department of PathologySant’Anna HospitalTurinItaly
  4. 4.Department of PathologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  5. 5.Department of Biological Science and Human OncologyUniversity of TurinTurinItaly
  6. 6.Pathologische OntleedkundeUniversity Hospitals LeuvenLeuvenBelgium
  7. 7.2nd Department of PathologySemmelweis UniversityBudapestHungary
  8. 8.Sezione Anatomia Patologica M. MalpighiUniversita di BolognaBolognaItaly
  9. 9.Service d’ Anatomie PathologiqueHopital de HautepierreStrasbourgFrance
  10. 10.Department of Pathology and CytologyKalmar HospitalKalmarSweden
  11. 11.Instituto de Patologia e Imunologia da Universidade do Porto (IPATIMUP) and Hospital de S. JoãoPortoPortugal
  12. 12.Institute of PathologyDonauspitalWienAustria
  13. 13.Gerhard-Domagk Institut fur PathologieUniversitat von MunsterMunsterGermany
  14. 14.Laboratorio De HistopatologicaCentro Regional De Oncologia De CoimbraCoimbraPortugal
  15. 15.Department of InformaticsBács-Kiskun County Teaching HospitalKecskemétHungary

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