Open AccessSentinel Lymph Node Biopsy for Risk‐Reducing Mastectomy
Author(s) -
Burger Amy,
Thurtle David,
Owen Sally,
Mannu Gurdeep,
Pilgrim Simon,
Vinayagam Raman,
Pain Simon
Publication year - 2013
Publication title -
the breast journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.533
H-Index - 72
eISSN - 1524-4741
pISSN - 1075-122X
DOI - 10.1111/tbj.12157
Subject(s) - medicine , sentinel lymph node , biopsy , occult , axillary lymph node dissection , breast cancer , mastectomy , sentinel node , radiology , prophylactic mastectomy , surgery , cancer , pathology , alternative medicine
Risk‐reducing mastectomy ( RRM ) confers 90–95% decreased risk of breast cancer, and may reduce mortality, especially in high‐risk groups such as BRCA carriers. Risk of occult disease in RRM specimen is ~5%. This demands axillary staging: sentinel lymph node ( SLN ) biopsy is no longer possible, axillary clearance confers significant risks and may prove negative. Contemporaneous SLN biopsy allows axillary staging with minimal further dissection. Women undergoing RRM and SLN biopsy between June 2005 and July 2010 were reviewed retrospectively from our prospectively maintained database of 1,522 SLN procedures in 1,498 patients. SLN (s) localized using routine tracer methods. SLN s and mastectomy specimens underwent routine histologic examination. Eighty‐three RRM s with SLN biopsy were performed in 71 patients (12 bilateral). Indications for RRM : contralateral invasive (55), in situ (5) disease, BRCA 1/2 mutation (12), and strong family history (10). Mean number of SLN s: 1.35. Occult disease was detected in four cases (4.8%), with one case of occult invasive lobular carcinoma (1.2%). Remaining occult disease was lobular in situ neoplasia ( LISN ). SLN s were negative in all cases. Our findings are comparable to those in the literature: 4.8% rate of occult disease overall, 1.2% invasive. The significant risk with SLN biopsy is lymphoedema, quoted around 7%. We have had no reports of symptomatic lymphoedema in patients undergoing RRM and SLN biopsy. We propose that SLN at the time of mastectomy requires only limited further dissection, and confers minimal risk compared with secondary axillary surgery.