Sentinel Lymph Node Biopsy in Multicentric Breast Cancer: Five-Year Results in a Large Series from a Single Institution
- 269 Downloads
This study was designed to present the 5-year results of patients with multicentric breast cancer who underwent sentinel lymph node biopsy (SLNB) in a single institution.
Between June 1999 and December 2007, 337 patients with multicentric breast cancer and a clinically negative axilla underwent lymphatic mapping by a single periareolar/peritumoral (n = 306) or a double peritumoral or subdermal injection (n = 31) of 99mTc-HSA nanocolloids. The sentinel lymph node (SLN) was evaluated by intraoperative frozen section and axillary dissection was performed only in cases of positive SLNB.
The median age of the patients was 48 (range, 22–81) years. The mean number of hot spots identified was 1.4 in the whole series, 1.3 in patients who received a single injection, and 1.7 in those who received a double injection (P < 0.001). The mean number of removed SLNs was 1.7 (median, 1; range, 1–7) with an identification rate of 100%. A total of 138 patients with negative SLNB (n = 134) or isolated tumor cells in the SLN (n = 4) did not receive completion axillary lymph node dissection (CALND). In these latter patients, a total of 27 events (19.5%) occurred with 3 patients (2.2%) developing axillary recurrences after a median follow-up of 5 years (range, 17–134 months).
Axillary lymph node reappearance was infrequent among patients with multicentric breast cancer, having negative SLNB and no CALND. We recommend SLNB as the standard procedure for nodal staging in patients with multicentric breast cancer and a clinically negative axilla.
KeywordsSentinel Lymph Node Sentinel Lymph Node Biopsy Axillary Dissection Isolate Tumor Cell Axillary Recurrence
The authors are greatly thankful to A.I.R.C. (Associazione Italiana per la Ricerca contro il Cancro), which supported clinical research on sentinel lymph node biopsy. We also thank William Russell-Edu, Librarian, European Institute of Oncology, for revising the English text and the Umberto Veronesi Foundation for supporting this research.
- 9.Giard S, Chauvet M-P, Penel N, et al. Feasibility of sentinel lymph node biopsy in multiple unilateral synchronous breast cancer: results of a French prospective multi-institutional study (IGASSU 0502). Ann Oncol. 2010;21(8):1630–5. Epub 2010 Jan 20.Google Scholar
- 10.Gentilini O, Trifirò G, Soteldo J, et al. Sentinel lymph node biopsy in multicentric breast cancer. The experience of the European Institute of Oncology. Eur J Surg Oncol. 2006;32(5):507–10. Epub 2006 Apr 3.Google Scholar
- 11.Marubini E., Valsecchi M.G. Analysing survival data from clinical trials and observational studies. Chichester, England: Wiley 1995: 331.Google Scholar
- 12.International Breast Cancer Study Group, Rudenstam CM, Zahrieh D, Forbes JF, et al. Randomized trial comparing axillary clearance versus no axillary clearance in older patients with breast cancer: first results of International Breast Cancer Study Group Trial 10–93. J Clin Oncol. 2006;24(3):337–44. Epub 2005 Dec 12.Google Scholar
- 13.Goldhirsch A, Ingle JN, Gelber RD, Coates AS, Thürlimann B, Senn H-J and Panel members. Thresholds for therapies: highlights of the St Gallen International Expert Consensus on the primary therapy of early breast cancer 2009. Ann Oncol. 2009;20(8):1319–29. Epub 2009 Jun 17.Google Scholar
- 16.Giuliano AE, McCall L, Beitsch P, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases. Ann Surg. 2010;252(3):426–32; discussion 432–3.Google Scholar
- 17.Veronesi U, Galimberti V, Paganelli G, et al. (2009) Axillary metastases in breast cancer patients with negative sentinel nodes: a follow up of 3548 cases. Eur J Cancer. 45(8):1381–8. Epub 2009 Jan 6. Google Scholar