Breast Cancer

, 17:9 | Cite as

Axillary lymph node dissection can be avoided in women with breast cancer with intraoperative, false-negative sentinel lymph node biopsies

  • Hiroyuki Takei
  • Masafumi Kurosumi
  • Takashi Yoshida
  • Yuko Ishikawa
  • Yuji Hayashi
  • Jun Ninomiya
  • Katsunori Tozuka
  • Hanako Oba
  • Kenichi Inoue
  • Shigenori Nagai
  • Yoshihiro Saito
  • Tomoko Kazumoto
  • Jun-ichi Saitoh
  • Toshio Tabei
Special Feature Pitfalls in sentinel lymph node biopsy



It is currently unclear which patients with breast cancer with sentinel lymph node (SLN) metastases do not need axillary lymph node dissection (ALND).

Patients and methods

A cohort of 1,132 women who had unilateral invasive breast cancer with clinically negative nodes or nodes suspicious for metastasis, were intraoperatively diagnosed as having negative SLNs, and did not undergo an immediate ALND. Our intraoperative histological investigation uses H&E staining of a frozen section from a maximum cut surface of each SLN. Of these 1,132 women, 132 (11.7%) were postoperatively diagnosed as having positive SLNs, which classifies them as having an intraoperative, false-negative SLN biopsy (SLNB). Patient and tumor characteristics, treatment methods, and the prognoses of these patients were investigated and compared with the remaining 1,000 patients who were negative for SLNB.


Of the 132 patients with intraoperative, false-negative SLNB, none underwent a further ALND. With a median follow-up period of 58.1 months, none of these patients exhibited recurrence in the axillary nodes. Their recurrence-free survival rates were not statistically different from those of patients with negative SLNB.


ALND can be avoided in most patients with breast cancer with intraoperative, false-negative SLNB.


Breast cancer Sentinel lymph node biopsy (SLNB) Intraoperative false-negative SLNB Axillary lymph node dissection Recurrence 



Axillary lymph node dissection


Confidence interval


Invasive ducal carcinoma not otherwise specified


Isolated tumor cells


Lymphovascular invasion


Sentinel lymph node


Sentinel lymph node biopsy


Radiation therapy


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Copyright information

© The Japanese Breast Cancer Society 2009

Authors and Affiliations

  • Hiroyuki Takei
    • 1
  • Masafumi Kurosumi
    • 2
  • Takashi Yoshida
    • 1
  • Yuko Ishikawa
    • 1
  • Yuji Hayashi
    • 1
  • Jun Ninomiya
    • 1
  • Katsunori Tozuka
    • 1
  • Hanako Oba
    • 2
  • Kenichi Inoue
    • 3
  • Shigenori Nagai
    • 3
  • Yoshihiro Saito
    • 4
  • Tomoko Kazumoto
    • 4
  • Jun-ichi Saitoh
    • 4
  • Toshio Tabei
    • 3
  1. 1.Division of Breast SurgerySaitama Cancer CenterSaitamaJapan
  2. 2.Department of PathologySaitama Cancer CenterSaitamaJapan
  3. 3.Division of Breast OncologySaitama Cancer CenterSaitamaJapan
  4. 4.Department of RadiologySaitama Cancer CenterSaitamaJapan

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