J Breast Cancer.  2011 Dec;14(4):296-300. 10.4048/jbc.2011.14.4.296.

How Many Sentinel Lymph Nodes Are Enough for Accurate Axillary Staging in T1-2 Breast Cancer?

Affiliations
  • 1Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. bwpark@yuhs.ac
  • 2Department of Pathology, Yonsei University College of Medicine, Seoul, Korea.
  • 3Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea.

Abstract

PURPOSE
During a sentinel lymph node biopsy (SLNB) for breast cancer, the appropriate number of sentinel lymph nodes (SLNs) to be removed for accurate axillary staging is still controversial. We hypothesized that there might be an optimal threshold number of SLNs. We investigated how many SLNs should be removed to achieve an acceptable accuracy and ensure minimal morbidity.
METHODS
We reviewed data of 328 patients with invasive breast cancer who underwent SLNB followed by complete level I and II axillary dissection between January 2004 and December 2005. The false negative rate (FNR) and accuracy of SLNB according to the number of removed SLNs were evaluated.
RESULTS
The mean number of SLNs removed was 3.0 (range, 1-14), and that of total retrieved axillary lymph nodes was 17.5 (range, 10-40). In total, 111 (33.8%) patients had positive nodes on the permanent pathological report. Among them, 12 patients had negative SLNs; thus, the overall FNR of SLNB was 10.8% (12/111) and the accuracy was 96.3% (316/328). The FNR was 26.6% for a single SLN, 8.0% for two, and 11.1% for three. In cases where four or more SLNs were removed, the FNR decreased to 0% and accuracy reached 100%.
CONCLUSION
Our data suggest that a SLNB should not only remove one or two of the hottest node(s) when other hot nodes exist. We also suggest that four might be an optimal threshold number of SLNs to be removed and that removal of more than four SLNs does not improve axillary staging accuracy.

Keyword

Breast neoplasms; False negative rate; Sentinel lymph node biopsy

MeSH Terms

Breast
Breast Neoplasms
Dietary Sucrose
Humans
Lymph Nodes
Nitriles
Pyrethrins
Sentinel Lymph Node Biopsy
Dietary Sucrose
Nitriles
Pyrethrins

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