Sentinel Node Biopsy in Breast Cancer Patients with Large or Multifocal Tumors

  • Tuomo J. Meretoja
  • Marjut H. Leidenius
  • Päivi S. Heikkilä
  • Heikki Joensuu
Breast Oncology

Abstract

Background

The axillary recurrence (AR) rate after negative sentinel node biopsy (SNB) in patients with high risk of axillary metastases is largely unknown. The aim of this study was to analyze the risk factors for isolated AR after negative SNB with special interest in large or multifocal tumors.

Methods

A prospective SNB registry was analyzed for 2,408 invasive breast cancer patients operated between 2001 and 2007. No axillary clearance was performed in 1,309 cases with a negative SNB, including 1,138 small unifocal tumors, 121 small multifocal tumors, 48 large unifocal tumors, and 2 large multifocal tumors.

Results

Six (0.5%) isolated AR were observed during a median follow-up of 43 months. Four (0.4%) patients with small unifocal tumors and two (1.6%) with small multifocal tumors had isolated AR (p = 0.179). None of the patients with large unifocal or multifocal tumors had isolated AR. Instead of tumor size and multifocality, estrogen receptor negativity (p < 0.001), nuclear grade III (p < 0.001), Her-2 status (p = 0.002), no radiotherapy (p = 0.005), and mastectomy (p = 0.005) were found to be associated with AR.

Conclusions

A remarkable proportion of patients with large unifocal tumors and small multifocal tumors may avoid unnecessary AC due to tumor negative SNB, without an excessive risk of AR.

References

  1. 1.
    Kim T, Giuliano AE, Lyman GH. Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a metaanalysis. Cancer. 2006;106(1):4–16.PubMedCrossRefGoogle Scholar
  2. 2.
    Zavagno G, Carcoforo P, Franchini Z, et al. Axillary recurrence after negative sentinel lymph node biopsy without axillary dissection: a study on 479 breast cancer patients. Eur J Surg Oncol. 2005;31(7):715–20.PubMedCrossRefGoogle Scholar
  3. 3.
    Bergkvist L, de Boniface J, Jonsson PE, Ingvar C, Liljegren G, Frisell J. Axillary recurrence rate after negative sentinel node biopsy in breast cancer: three-year follow-up of the Swedish Multicenter Cohort Study. Ann Surg. 2008;247(1):150–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Imoto S, Wada N, Murakami K, Hasebe T, Ochiai A, Ebihara S. Prognosis of breast cancer patients treated with sentinel node biopsy in Japan. Jpn J Clin Oncol. 2004;34(8):452–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Cody HS, III. Sentinel lymph node biopsy for breast cancer: does anybody not need one? Ann Surg Oncol. 2003;10(10):1131–2.PubMedCrossRefGoogle Scholar
  6. 6.
    Costa A, Zurrida S, Gatti G, et al. Less aggressive surgery and radiotherapy is the way forward. Curr Opin Oncol. 2004;16(6):523–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Goyal A, Newcombe R, Chhabra A, Mansel R. Factors affecting failed localisation and false-negative rates of sentinel node biopsy in breast cancer–results of the ALMANAC validation phase. Breast Cancer Res Treat. 2006;99(2):203–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Krag D, Anderson S, Julian T, et al. Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial. Lancet Oncol. 2007;8(10):881–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Schule J, Frisell J, Ingvar C, Bergkvist L. Sentinel node biopsy for breast cancer larger than 3 cm in diameter. Br J Surg. 2007;94(8):948–51.PubMedCrossRefGoogle Scholar
  10. 10.
    Olson JJ, Fey J, Winawer J, et al. Sentinel lymphadenectomy accurately predicts nodal status in T2 breast cancer. J Am Coll Surg. 2000;191(6):593–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Bedrosian I, Reynolds C, Mick R, et al. Accuracy of sentinel lymph node biopsy in patients with large primary breast tumors. Cancer. 2000;88(11):2540–5.PubMedCrossRefGoogle Scholar
  12. 12.
    Wong S, Chao C, Edwards M, et al. Accuracy of sentinel lymph node biopsy for patients with T2 and T3 breast cancers. Am Surg. 2001;67(6):522–6 (discussion 527–8).PubMedGoogle Scholar
  13. 13.
    Chung M, Ye W, Giuliano A. Role for sentinel lymph node dissection in the management of large (>; or =5 cm) invasive breast cancer. Ann Surg Oncol. 2001;8(9):688–92.PubMedGoogle Scholar
  14. 14.
    Kim HJ, Lee JS, Park EH, et al. Sentinel node biopsy in patients with multiple breast cancer. Breast Cancer Res Treat. 2008;109(3):503–6.PubMedCrossRefGoogle Scholar
  15. 15.
    D’Eredita G, Giardina C, Ingravallo G, Rubini G, Lattanzio V, Berardi T. Sentinel lymph node biopsy in multiple breast cancer using subareolar injection of the tracer. Breast. 2007;16(3):316–22.PubMedCrossRefGoogle Scholar
  16. 16.
    Bergkvist L, Frisell J. Multicentre validation study of sentinel node biopsy for staging in breast cancer. Br J Surg. 2005;92(10):1221–4.PubMedCrossRefGoogle Scholar
  17. 17.
    Ozmen V, Muslumanoglu M, Cabioglu N, et al. Increased false negative rates in sentinel lymph node biopsies in patients with multi-focal breast cancer. Breast Cancer Res Treat. 2002;76(3):237–44.PubMedCrossRefGoogle Scholar
  18. 18.
    Barone JE, Tucker JB, Perez JM, Odom SR, Ghevariya V. Evidence-based medicine applied to sentinel lymph node biopsy in patients with breast cancer. Am Surg. 2005;71(1):66–70.PubMedGoogle Scholar
  19. 19.
    Leidenius MH, Krogerus LA, Toivonen TS, von Smitten KA. Sentinel node biopsy is not sensible in breast cancer patients with large primary tumours. Eur J Surg Oncol. 2005;31(4):364–8.PubMedCrossRefGoogle Scholar
  20. 20.
    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(2):319–25.PubMedCrossRefGoogle Scholar
  21. 21.
    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(10):1245–52.PubMedCrossRefGoogle Scholar
  22. 22.
    Christiansen P, Friis E, Balslev E, Jensen D, Moller S. Sentinel node biopsy in breast cancer: five years experience from Denmark. Acta Oncol. 2008;47(4):561–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Leidenius MH, Vironen JH, Riihela MS, et al. The prevalence of non-sentinel node metastases in breast cancer patients with sentinel node micrometastases. Eur J Surg Oncol. 2005;31(1):13–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Sobin LH, Wittekind Ch. TNM classification of malignant tumours, 6th ed. New-York: Wiley-Liss; 2002.Google Scholar
  25. 25.
    van der Ploeg IM, Nieweg OE, van Rijk MC, Valdes Olmos RA, Kroon BB. Axillary recurrence after a tumour-negative sentinel node biopsy in breast cancer patients: A systematic review and meta-analysis of the literature. Eur J Surg Oncol. 2008;34(12):1277–84.PubMedGoogle Scholar
  26. 26.
    Deurloo E, Tanis P, Gilhuijs K, et al. Reduction in the number of sentinel lymph node procedures by preoperative ultrasonography of the axilla in breast cancer. Eur J Cancer. 2003;39(8):1068–73.PubMedCrossRefGoogle Scholar
  27. 27.
    van Wely B, Smidt M, de Kievit I, Wauters C, Strobbe L. False-negative sentinel lymph node biopsy. Br J Surg. 2008;95(11):1352–5.PubMedCrossRefGoogle Scholar
  28. 28.
    Takei H, Suemasu K, Kurosumi M, et al. Recurrence after sentinel lymph node biopsy with or without axillary lymph node dissection in patients with breast cancer. Breast Cancer. 2007;14(1):16–24.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2009

Authors and Affiliations

  • Tuomo J. Meretoja
    • 1
  • Marjut H. Leidenius
    • 1
  • Päivi S. Heikkilä
    • 2
  • Heikki Joensuu
    • 3
  1. 1.Department of Gastrointestinal and General Surgery, Breast Surgery UnitHelsinki University Central HospitalHelsinkiFinland
  2. 2.Department of PathologyHelsinki University Central HospitalHelsinkiFinland
  3. 3.Department of OncologyHelsinki University Central HospitalHelsinkiFinland

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