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Treatment implications of a positive sentinel lymph node biopsy for patients with early‐stage breast carcinoma
Author(s) -
Chua Boon,
Ung Owen,
Taylor Richard,
Bilous Michael,
Salisbury Elizabeth,
Boyages John
Publication year - 2001
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(20011001)92:7<1769::aid-cncr1692>3.0.co;2-6
Subject(s) - medicine , sentinel lymph node , axilla , stage (stratigraphy) , axillary lymph node dissection , biopsy , breast carcinoma , metastasis , primary tumor , breast cancer , radiology , oncology , cancer , paleontology , biology
BACKGROUND Sentinel lymph node (SLN) mapping and biopsy is emerging as an alternative to axillary lymph node dissection (ALND) in determining the lymph node status of patients with early‐stage breast carcinoma. The hypothesis of the technique is that the SLN is the first lymph node in the regional lymphatic basin that drains the primary tumor. Non‐SLN (NSLN) metastasis in the axilla is unlikely if the axillary SLN shows no tumor involvement, and, thus, further axillary interference may be avoided. However, the optimal treatment of the axilla in which an SLN metastasis is found requires ongoing evaluation. The objectives of this study were to evaluate the predictors for NSLN metastasis in the presence of a tumor‐involved axillary SLN and to examine the treatment implications for patients with early‐stage breast carcinoma. METHODS Between June 1998 and May 2000, 167 patients participated in the pilot study of SLN mapping and biopsy at Westmead Hospital. SLNs were identified successfully and biopsied in 140 axillae. All study patients also underwent ALND. The incidence of NSLN metastasis in the 51 patients with a SLN metastasis was correlated with clinical and pathologic characteristics. RESULTS Of 51 patients with a positive SLN, 24 patients (47%) had NSLN metastases. The primary tumor size was the only significant predictor for NSLN involvement. NSLN metastasis occurred in 25% of patients (95% confidence interval [95%CI], 10–47%) with a primary tumor size ≤ 20 mm and in 67% of patients (95%CI, 46–83%) with a primary tumor size > 20 mm ( P = 0.005). The size of the SLN metastasis was not associated significantly with NSLN involvement. Three of 7 patients (43%) with an SLN micrometastasis (< 1 mm) had NSLN involvement compared with 38 of 44 patients (48%) with an SLN macrometastasis (≥ 1 mm). CONCLUSIONS The current study did not identify a subgroup of SLN positive patients in whom the incidence of NSLN involvement was low enough to warrant no further axillary interference. At present, a full axillary dissection should be performed in patients with a positive SLN. Cancer 2001;92:1769–74. © 2001 American Cancer Society.