This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (59)  • Contact me when this article is cited  Related Content  • Related articles  • Similar articles in this journal  Topic Collections  • Breast Cancer  • Surgical Oncology  • Alert me on articles by topic  Social Bookmarking   What's this?

A Multicenter Study

Sandra L. Wong, MD; Michael J. Edwards, MD; Celia Chao, MD; Todd M. Tuttle, MD; R. Dirk Noyes, MD; Claudine Woo, MPH; Patricia B. Cerrito, PhD; Kelly M. McMasters, MD,PhD; for the University of Louisville Breast Cancer Sentinel Lymph Node Study Group

Arch Surg. 2001;136:563-568.

Background  Sentinel lymph node (SLN) biopsy is a minimally invasive procedure that provides accurate nodal staging information. The need for completion axillary dissection after finding a positive SLN for breast cancer has been questioned.

Hypothesis  The presence of nonsentinel node (NSN) metastases in the axillary dissection specimen correlates with tumor size, the number of SLNs removed, and the number of positive SLNs.

Design  Prospective, multi-institutional study.

Participants and Methods  The University of Louisville Breast Cancer Sentinel Lymph Node Study is a nationwide study involving 148 surgeons. All patients underwent SLN biopsy, followed by level I/II axillary dissection. All SLNs were evaluated histologically at a minimum of 2-mm intervals. Immunohistochemical analysis using antibodies for cytokeratin was performed at the discretion of each participating institution. All NSNs were evaluated by routine histologic examination.

Results  An SLN was identified in 1268 (90%) of 1415 patients. Increasing tumor size was significantly correlated with increasing likelihood of positive NSNs: T1a, 14%; T1b, 22%; T1c, 30%; T2, 45%; and T3, 57% (P = .002, ² test). The presence of positive NSNs was not significantly associated with the number of SLNs removed. Patients with more than 1 positive SLN were more likely to have positive NSNs than those with only 1 positive SLN (50% vs 32%; P<.001, ² test). Increasing tumor size and the presence of multiple positive SLNs were also associated with the presence 4 or more positive axillary nodes. Multivariate analysis confirmed that tumor size and the number of positive SLNs were independent factors predicting the presence of positive NSNs.

Conclusions  The likelihood of positive NSNs correlates with increasing tumor size and the presence of multiple positive SLNs. However, even patients with small primary tumors have a substantial risk of residual axillary nodal disease after SLN biopsy. These data will be helpful in counseling patients regarding the need for completion axillary dissection after a positive SLN is identified.

From the Division of Surgical Oncology, Department of Surgery (Drs Wong, Edwards, Chao, and McMasters), and the Department of Mathematics (Dr Cerrito), University of Louisville, Louisville, Ky; Park Nicollet Clinic, Minneapolis, Minn (Dr Tuttle); LDS Hospital, Salt Lake City, Utah (Dr Noyes); and the Department of Epidemiology, The Johns Hopkins School of Hygiene and Public Health, Baltimore, Md (Ms Woo).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED ARTICLES

This Month in Archives of Surgery
Arch Surg. 2001;136(5):498.
FULL TEXT  

Archives of Surgery Reader's Choice: Continuing Medical Education
Arch Surg. 2001;136(5):605.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Impact and Remaining Challenges in the Use of Sentinel Lymph Node Biopsy in Early-stage Breast Cancer
Lyman et al.
Am Soc Clin Oncol Ed Book 2009;2009:346-353.
ABSTRACT | FULL TEXT  

S-Classification of Sentinel Lymph Node Predicts Axillary Nonsentinel Lymph Node Status in Patients with Breast Cancer
Fink et al.
Ann. Surg. Oncol. 2008;15:848-853.
ABSTRACT | FULL TEXT  

Evaluation of Three Scoring Systems Predicting Non Sentinel Node Metastasis in Breast Cancer Patients with a Positive Sentinel Node Biopsy
Dauphine et al.
Ann. Surg. Oncol. 2007;14:1014-1019.
ABSTRACT | FULL TEXT  

Micrometastases in Sentinel Lymph Node in a Multicentric Study: Predictive Factors of Nonsentinel Lymph Node Involvement--Groupe Des Chirurgiens De La Federation Des Centres De Lutte Contre Le Cancer
Houvenaeghel et al.
JCO 2006;24:1814-1822.
ABSTRACT | FULL TEXT  

Predicting Extensive Nodal Disease in Women With Breast Cancer
Chagpar
Ann. Surg. Oncol. 2006;13:3-4.
FULL TEXT  

Clinicopathologic Features Associated With Having Four or More Metastatic Axillary Nodes in Breast Cancer Patients With a Positive Sentinel Lymph Node
Rivers et al.
Ann. Surg. Oncol. 2006;13:36-44.
ABSTRACT | FULL TEXT  

Case 35-2005 -- A 56-Year-Old Woman with Breast Cancer and Isolated Tumor Cells in a Sentinel Lymph Node
Davidson et al.
NEJM 2005;353:2177-2185.
FULL TEXT  

American Society of Clinical Oncology Guideline Recommendations for Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer
Lyman et al.
JCO 2005;23:7703-7720.
ABSTRACT | FULL TEXT  

The Effect of Sentinel Node Tumor Burden on Non-Sentinel Node Status and Recurrence Rates in Breast Cancer
Fan et al.
Ann. Surg. Oncol. 2005;12:705-711.
ABSTRACT | FULL TEXT  

Sentinel Lymph Node Tumor Load: An Independent Predictor of Additional Lymph Node Involvement and Survival in Melanoma
Vuylsteke et al.
Ann. Surg. Oncol. 2005;12:440-448.
ABSTRACT | FULL TEXT  

Further Results of Incorporating Innovative Procedures in a Surgical Residency
Kehdy et al.
SURG INNOV 2005;12:167-171.
ABSTRACT  

Axillary Sentinel Node and Tumour-related Factors Associated with Non-sentinel Node Involvement in Breast Cancer
Cserni et al.
Jpn J Clin Oncol 2004;34:519-524.
ABSTRACT | FULL TEXT  

Influence of the New AJCC Breast Cancer Staging System on Sentinel Lymph Node Positivity and False-Negative Rates
McCready et al.
JNCI J Natl Cancer Inst 2004;96:873-875.
ABSTRACT | FULL TEXT  

The Eternally Enigmatic Axilla: Further Controversy About Axillary Lymph Nodes in Breast Cancer
McMasters
Ann. Surg. Oncol. 2003;10:1128-1130.
FULL TEXT  

A Nomogram for Predicting the Likelihood of Additional Nodal Metastases in Breast Cancer Patients With a Positive Sentinel Node Biopsy
Van Zee et al.
Ann. Surg. Oncol. 2003;10:1140-1151.
ABSTRACT | FULL TEXT  

Nonvisualization of Axillary Sentinel Node During Lymphoscintigraphy: Is There a Pathologic Significance in Breast Cancer?
Brenot-Rossi et al.
JNM 2003;44:1232-1237.
ABSTRACT | FULL TEXT  

Clinicopathologic Factors Predicting Involvement of Nonsentinel Axillary Nodes in Women With Breast Cancer
Hwang et al.
Ann. Surg. Oncol. 2003;10:248-254.
ABSTRACT | FULL TEXT  

Preliminary Outcome Analysis in Patients With Breast Cancer and a Positive Sentinel Lymph Node Who Declined Axillary Dissection
Fant et al.
Ann. Surg. Oncol. 2003;10:126-130.
ABSTRACT | FULL TEXT  

Complete sectioning of axillary sentinel nodes in patients with breast cancer. Analysis of two different step sectioning and immunohistochemistry protocols in 246 patients
Cserni
J. Clin. Pathol. 2002;55:926-931.
ABSTRACT | FULL TEXT