Abstract
Background: Multicentric or multifocal breast cancer is considered a limitation for sentinel lymph node biopsy (SLNB). Studies showing that all quadrants of the breast drain via common afferent lymphatic channels indicate that multiple tumors do not affect lymphatic drainage. We therefore assessed the accuracy of SLNB in patients with multiple breast tumors. Methods: Of the 942 breast cancer patients who underwent SLNB using radioisotope at Asan Medical Center between January 2003 and December 2006, 803 had unifocal and 139 had multiple tumors. Axillary dissection after SLNB was performed on 884 patients, 757 with unifocal and 127 with multiple tumors. All patients underwent lymphatic scintigram for removal of sentinel lymph nodes (SLNs). The clinical characteristics and accuracy of SLNB was compared in patients with unifocal and multiple breast cancer. Results: In the multiple tumor group, 2.68 ± 0.84 SLNs were identified in 136 of 139 patients (identification rate, 97.84%); 81.5% of SLNs were identified by scintigram. The incidence of axillary metastases was 29.50% (41/139). SLNB accuracy was 97.63% (124/127), with a false negative (FN) rate of 7.89% (3/38). In the unifocal group, 2.67 ± 0.96 SLNs were identified in 787 of 803 patients (identification rate, 98.00%); 84.8% of SLNs were identified by scintigram. The incidence of axillary metastasis was 22.04% (177/803). SLNB accuracy was 98.02% (742/757), with a FN rate of 8.62% (15/174). The accuracy and FN rate of SLNB did not differ significantly between unifocal and multiple breast cancer. Conclusion: The accuracy of SLNB in multiple breast cancer is comparable to its accuracy in unifocal cancer. These findings indicate that SLNB can be used an as alternative to complete axillary lymph node dissection in patients with multiple breast tumors.
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Schwartz GF, Guiliano AE, Veronesi U (2002) Proceeding of the consensus conference of the role of sentinel lymph node biopsy in carcinoma or the breast. In: The breast 8(3):124–138
D’Eredita G, Giardina C, Ingravallo G et al (2007) Sentinel lymph node biopsy in multiple breast cancer using subareolar injection of the tracer. The breast 16(3):316–322
Layeeque R, Tilman RH, Korourian S et al (2003) Subareolar sentinel node biopsy for multiple breast cancers. Am J Surg 186:730–736
Goyal A, Newcombe RG, Mansel RE et al (2004) Sentinel lymph node biopsy in patients with multifocal breast cancer. EJSO 30:475–479
Klimberg VS, Rubio IT, Henry R et al (1999) Subareolar versus peritumoral injection for location of sentinel lymph node. Ann Surg 229:860–864
Tuttle TM, Colbert M, Christensen R et al (2002) Subareolar injection of 99 m-Tc facilitates sentinel lymph node identification. Ann Surg Oncol 9:77–81
Borgstein PJ, Meijer S, Pijpers R (1997) Intradermal blue dye to identify sentinel lymph node in breast cancer. Lancet 349:1668–1669
Chao C, Wong SL, Woo C et al (2001) Reliable lymphatic drainage to axillary sentinel lymph nodes regardless of tumor location within the breast. Am J Surg 182:307–311
Kern KA (2001) lymphoscintigraphic anatomy of sentinel lymphatic channels after subareolar injection of technetium 99 m sulfur colloid. J Am Coll Surg 193:601–608
Mertz L, Mathelin C, Marin C et al (1999) Subareolar injection of 99m-Tc sulfur colloid for sentinel node identification in multifocal invasive breast cancer. Bull Cancer 86:939–945
Schrenk P, Wayand W (2001) Sentinel-node biopsy in axillary lymph node staging for patients with multicentric breast cancer. Lancet 357:122
Kumar R, Jana S, Heiba SI et al (2003) Retrospective analysis of sentinel node localization in multifocal, multicentric, palpable or nonpalpable breast cancer. J Nucl Med 44:7–10
Kumar R, Scott P, Abass A (2004) Sentinel lymph node biopsy in multifocal and multicentric breast cancer. J Am Coll Surg 198:674–676
Ferrari A, Dionigi P, Rovera F et al (2006) Multifocality and multicentricity are not contraindications for sentinel lymph node biopsy in breast cancer surgery. World J Surg Oncol 4:79–86
Ozmen V, Muslumanoglu M, Cobioglu N et al (2002) Increased false negative rate in sentinel lymph node biopsies in patients with multifocal breast cancer. Breast Cancer Res Treat 76:237–244
Tousimis E, Van Zee KJ, Fey JV et al (2003) The accuracy of sentinel lymph node biopsy in multicentric and multifocal invasive breast cancer. J Am Coll Surg 197:529–535
Gentilini O, Tririfo G, Soteldo J et al (2006) Sentinel lymph node biopsy in multicentric breast cancer. The experience of the European Institute of Oncology. Eur J Surg Oncol 32:507–510
Kim JH, Heerdts AS, Cody HS, Van Zee KJ (2002) Sentinel lymph node drainage in multicentric breast cancer. Breast J 8:356–361
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Kim, H.J., Lee, J.S., Park, E.H. et al. Sentinel node biopsy in patients with multiple breast cancer. Breast Cancer Res Treat 109, 503–506 (2008). https://doi.org/10.1007/s10549-007-9674-9
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DOI: https://doi.org/10.1007/s10549-007-9674-9