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Anees B. Chagpar, MD, MSc; Charles R. Scoggins, MD; Robert C. G. Martin II, MD; David J. Carlson, MD; Alison L. Laidley, MD; Souzan E. El-Eid, MD; Terre Q. McGlothin, MD; Kelly M. McMasters, MD, PhD; for the University of Louisville Breast Sentinel Lymph Node Study Investigators

Arch Surg. 2007;142:456-460.

Hypothesis  It has recently been proposed that only 3 sentinel lymph nodes (SLNs) are required for an adequate SLN biopsy. Others have advocated removing all nodes that are blue, hot, at the end of a blue lymphatic channel, or palpably suspicious or that have radioactive counts of 10% or greater of the most radioactive SLN. Our objective was to determine the false-negative rate (FNR) associated with limiting SLN biopsy to 3 nodes.

Design  Multicenter prospective study.

Setting  Both academic and private practice.

Patients  A total of 4131 patients underwent SLN biopsy followed by completion axillary node dissection.

Main Outcome Measure  The FNR associated with 3-node SLN biopsy.

Results  Of the 4131 patients in this study, an SLN was identified in 3882 (94.0%). The median number of SLNs identified was 2; more than 3 SLNs were removed in 738 patients (17.9%). Of the patients in whom a SLN was identified, 1358 (35.0%) were node positive. The overall FNR in this study was 7.7%. In 89.7% of node-positive patients, a positive SLN was found in the first 3 SLNs removed. If SLN biopsy had been limited to the first 3 nodes, the FNR would be 10.3% (P = .005 compared with removing >3 SLNs). The FNR increased with the strategy of limiting SLN biopsy to fewer SLNs (P<.001).

Conclusion  Removing only 3 SLNs cannot be recommended, because it is associated with a substantially increased FNR.

Author Affiliations: Department of Surgery, University of Louisville, Louisville, Ky (Drs Chagpar, Scoggins, Martin, and McMasters); St Mary's Medical Center and Deaconess Hospital, Evansville, Ind (Dr Carlson); Breast Surgeons of North Texas, Dallas (Drs Chagpar, Scoggins, Martin, Carlson, Laidley, El-Eid, McGlothin, and McMasters); Richardson Regional Hospital, Richardson, Tex (Dr McGlothin); and Hudson Valley Surgical, Kingston, NY (Dr El-Eid).
Group Information: A complete list of investigators in the University of Louisville Breast Sentinel Lymph Node Study was published in Am J Surg. 2002;184:496-498.

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