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Three–Axillary Lymph Node Sampling for the Prediction of Nonsentinel Node Metastases in Breast Cancer Patients With Sentinel Node Metastases

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Abstract

Background

In half of breast cancer patients with positive sentinel nodes, the sentinel nodes are the only metastatic nodes. Such patients have no more metastatic nonsentinel nodes and do not need to undergo axillary lymph node dissection. The purpose of this study was to investigate whether three–axillary lymph node sampling after sentinel node biopsy predicts the status of nonsentinel nodes in patients with sentinel node metastases.

Methods

Sentinel node biopsy was performed with dye and radioisotope. When the sentinel nodes were diagnosed as metastasis positive by using intraoperative imprint cytology, three–axillary lymph node sampling was performed, followed by axillary lymph node dissection.

Results

Of 47 cases with positive imprint cytology, 43 (91%) were diagnosed as metastasis positive on their final histological examination and were analyzed. The status of the sampled nodes was significantly associated with the status of nonsentinel nodes (P < .0001). Six (43%) of 14 patients with positive sampled nodes had at least 1 positive remaining node. Only 2 (7%) of 29 patients whose sampled nodes were negative were found to have additional nodal metastases. The sensitivity, specificity, and accuracy of the sampled nodes for the prediction of nonsentinel node metastases were 87.5%, 100%, and 95.3%, respectively.

Conclusions

We demonstrated that three-node sampling may be useful for predicting the status of nonsentinel nodes and avoiding axillary lymph node dissection in patients with only sentinel node metastases.

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References

  1. Nieweg OE, Tanis PJ, Kroon BB. The definition of a sentinel node. Ann Surg Oncol 2001; 8:538–41

    PubMed  CAS  Google Scholar 

  2. Giuliano AE, Kirgan DM, Guenther JM, et al. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg 1994; 220:391–401

    PubMed  CAS  Google Scholar 

  3. Giuliano AE, Jones RC, Brennan M, et al. Sentinel lymphadenectomy in breast cancer. J Clin Oncol 1997; 15:2345–50

    PubMed  CAS  Google Scholar 

  4. Krag DN, Weaver DL, Alex JC, et al. Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe. Surg Oncol 1993; 2:335–9

    Article  PubMed  CAS  Google Scholar 

  5. Veronesi U, Paganelli G, Galimberti V, et al. Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes. Lancet 1997; 349:1864–7

    Article  PubMed  CAS  Google Scholar 

  6. Albertini JJ, Lyman GH, Cox CE, et al. Lymphatic mapping and sentinel node biopsy in the patient with breast cancer. JAMA 1996; 276:1818–22

    Article  PubMed  CAS  Google Scholar 

  7. Cox CE, Pendas S, Cox JM, et al. Guidelines for sentinel node biopsy and lymphatic mapping of patients with breast cancer. Ann Surg 1998; 227:645–53

    Article  PubMed  CAS  Google Scholar 

  8. Chu KU, Turner RR, Hansen NM, et al. Do all patients with sentinel node metastasis from breast carcinoma need complete axillary node dissection? Ann Surg 1999; 229:536–41

    Article  PubMed  CAS  Google Scholar 

  9. Reynolds C, Mick R, Donohue JH, et al. Sentinel lymph node biopsy with metastasis: can axillary dissection be avoided in some patients with breast cancer? J Clin Oncol 1999; 17:1720–6

    PubMed  CAS  Google Scholar 

  10. Viale G, Maiorano E, Mazzarol G, et al. Histologic detection and clinical implications of micrometastases in axillary sentinel lymph nodes for patients with breast carcinoma. Cancer 2001; 92:1378–84

    Article  PubMed  CAS  Google Scholar 

  11. Degnim AC, Griffith KA, Sabel MS, et al. Clinicopathologic features of metastasis in nonsentinel lymph nodes of breast carcinoma patients. Cancer 2003; 98:2307–15

    Article  PubMed  Google Scholar 

  12. Steele RJ, Forrest AP, Gibson T, et al. The efficacy of lower axillary sampling in obtaining lymph node status in breast cancer: a controlled randomized trial. Br J Surg 1985; 72:368–9

    PubMed  CAS  Google Scholar 

  13. Forrest AP, Everington D, McDonald CC, et al. The Edinburgh randomized trial of axillary sampling or clearance after mastectomy. Br J Surg 1995; 82:1504–8

    PubMed  CAS  Google Scholar 

  14. Motomura K, Inaji H, Komoike Y, et al. Combination technique is superior to dye alone in identification of the sentinel node in breast cancer patients. J Surg Oncol 2001; 76:95–9

    Article  PubMed  CAS  Google Scholar 

  15. Motomura K, Komoike Y, Hasegawa Y, et al. Intradermal radioisotope injection is superior to subdermal injection for the identification of the sentinel node in breast cancer patients. J Surg Oncol 2003;82:91–6

    Article  PubMed  Google Scholar 

  16. Motomura K, Inaji H, Komoike Y, et al. Intraoperative sentinel lymph node examination by imprint cytology and frozen sectioning during breast surgery. Br J Surg 2000; 87:597–601

    Article  PubMed  CAS  Google Scholar 

  17. American Joint Committee on Cancer. Breast. In: Greene FL, Page DL, Fleming ID, et al., (eds). AJCC Cancer Staging Handbook. 6th ed. New York: Springer, 2002:155–81

    Google Scholar 

  18. Elston CW, Ellis IO. Pathological prognostic factors in breast cancer. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology 1991; 19:403–10

    PubMed  CAS  Google Scholar 

  19. Cserni G, Gregori D, Merletti F, et al. Meta-analysis of non-sentinel node metastases associated with micrometastatic sentinel nodes in breast cancer. Br J Surg 2004; 91:1245–52

    Article  PubMed  CAS  Google Scholar 

  20. den Bakker MA, van Weeszenberg A, de Kanter AY, et al. Non-sentinel lymph node involvement in patients with breast cancer and sentinel node micrometastasis; too early to abandon axillary clearance. J Clin Pathol 2002; 55:932–5

    Article  Google Scholar 

  21. Rahusen FD, Torrenga H, van Diest PJ, et al. Predictive factors for metastatic involvement of nonsentinel nodes in patients with breast cancer. Arch Surg 2001; 136:1059–63

    Article  PubMed  CAS  Google Scholar 

  22. Hwang RF, Krishnamurthy S, Hunt KK, et al. Clinicopathologic factors predicting involvement of nonsentinel axillary nodes in women with breast cancer. Ann Surg Oncol 2003; 10:248–54

    Article  PubMed  Google Scholar 

  23. Morrow M. Is axillary dissection necessary after positive sentinel node biopsy? Yes! Ann Surg Oncol 2001; 8:74S–76S

    CAS  Google Scholar 

  24. Viale G, Maiorano E, Pruneri G, et al. Predicting the risk for additional axillary metastases in patients with breast carcinoma and positive sentinel lymph node biopsy. Ann Surg 2005; 241:319–25

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511, Japan

    Kazuyoshi Motomura MD, Chiyomi Egawa MD, Yoshifumi Komoike MD, Hiroki Koyama MD & Hideo Inaji MD

  2. Department of Cytology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511, Japan

    Sachiko Nagumo CT

Authors
  1. Kazuyoshi Motomura MD
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  2. Chiyomi Egawa MD
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  3. Yoshifumi Komoike MD
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  4. Sachiko Nagumo CT
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  5. Hiroki Koyama MD
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  6. Hideo Inaji MD
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Corresponding author

Correspondence to Kazuyoshi Motomura MD.

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Motomura, K., Egawa, C., Komoike, Y. et al. Three–Axillary Lymph Node Sampling for the Prediction of Nonsentinel Node Metastases in Breast Cancer Patients With Sentinel Node Metastases. Ann Surg Oncol 13, 985–989 (2006). https://doi.org/10.1245/ASO.2006.08.037

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  • DOI: https://doi.org/10.1245/ASO.2006.08.037

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