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Kathie-Ann Joseph, MD, MPH; Mahmoud El-Tamer, MD; Ian Komenaka, MD; Andrea Troxel, ScD; Beth Ann Ditkoff, MD; Freya Schnabel, MD

Arch Surg. 2004;139:648-651.

Hypothesis  The presence of nonsentinel lymph node (NSLN) metastasis after having a positive sentinel lymph node dissection finding is associated with tumor size and stage, the presence of lymphovascular invasion, micrometastasis, and extranodal extension.

Design  Retrospective case series.

Setting  University hospital.

Patients  Four hundred seven consecutive patients at a single institution who underwent sentinel lymph node dissection as part of breast conservation or mastectomy with biopsy-proved cancer.

Intervention  Completion axillary lymph node dissection and definitive therapy.

Main Outcome Measures  Sentinel node metastasis, NSLN metastasis, tumor size and stage, lymphovacular invasion, micrometastasis, extronodal extension, histological tumor characteristics, and number of sentinel nodes removed.

Results  In a univariate analysis, size of the primary tumor and extranodal extension were associated with having positive NSLN findings. The presence of micrometastasis was associated with negative NSLN findings. When all factors were included in a logistic regression analysis, the significant predictor of NSLN metastasis was extranodal extension (P = .002). Lymphovascular invasion was not associated with positive NSLN findings (P = .11). The number of sentinel nodes removed also had no bearing on the status of the NSLNs (P = .37).

Conclusions  Although primary tumor size and micrometastases correlate with the status of the NSLNs, extranodal extension is the most important independent predictor of NSLN metastasis. These findings may ultimately spare patients a full axillary lymph node dissection. However, pending results of larger clinical trials, full axillary lymph node dissection is still recommended for patients with sentinel lymph node metastases.

From the Department of Surgery, Columbia Presbyterian Comprehensive Breast Center, New York Presbyterian Hospital (Drs Joseph, El-Tamer, Komenaka, Ditkoff, and Schnabel), and the Department of Biostatistics, Mailman School of Public Health, Columbia University (Dr Troxel), New York, NY.

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