Surgical Management of the Axilla in Breast Cancer Patients with Negative Sentinel Lymph Node: A Method to Reduce False-Negative Rate

  • Qianqian Yuan
  • Gaosong WuEmail author
  • Shu-Yuan Xiao
  • Yukun He
  • Kun Wang
  • Dan Zhang
Original Scientific Report



False-negative rate (FNR) of sentinel lymph node dissection (SLND) has not been eliminated. The study was conducted to optimize the surgical resection of axilla in patients with negative sentinel lymph node (SLN) for the purpose of eradicating false-negative (FN) events of SLND.


A total of 312 clinically node-negative patients without neoadjuvant therapy underwent SLND with indocyanine green (ICG), methylene blue and the combination of ICG and methylene blue. Axillary dissection was performed subsequently regardless of the status of SLN. Lymph nodes were sent for pathological examination separately by serial resection every 0.5 cm away from marginally visualized SLNs.


SLND was successfully conducted in 98.1% (306/312) of patients using methylene blue, ICG, and its combination. Further examination revealed 97 true-positive, 189 true-negative, and 13 FN results. The overall FNR was 11.8% (13/110). A horizontal line 1.5 cm away from the superior vSLN and a vertical line 1.5 cm away from the medial vSLN formed a zone of lower outer quadrant (LOQ) in axilla. Surgical resection of LOQ ‘en bloc’ showed a FNR of zero.


The surgical management of axilla may benefit negative SLN patients with potential nodal involvement, reducing the FNR of SLND to zero.

Trial registration number and agency

This study was registered with the Chinese Clinical Trial Registry (ChiCTR1800014247).



The authors thank the studied patients for their willingness to cooperate with our study.

Compliance with ethical standards

Conflict of interest

All the authors report no conflict of interest.


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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Qianqian Yuan
    • 1
  • Gaosong Wu
    • 1
    Email author
  • Shu-Yuan Xiao
    • 2
    • 3
  • Yukun He
    • 1
  • Kun Wang
    • 4
  • Dan Zhang
    • 4
  1. 1.Department of Thyroid and Breast SurgeryZhongnan Hospital of Wuhan UniversityWuhanPeople’s Republic of China
  2. 2.Wuhan University Center for Pathology and Molecular DiagnosticsWuhanPeople’s Republic of China
  3. 3.Department of PathologyUniversity of ChicagoChicagoUSA
  4. 4.Department of Thyroid and Breast SurgeryTongji Hospital of Tongji Medical College of Huazhong University of Science and TechnologyWuhanPeople’s Republic of China

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