Sentinel lymph node as a new marker for therapeutic planning in breast cancer patients

Background and Objectives Literature review suggests that the sentinel lymph node (sN) represents a reliable predictor of axillary lymph node status in breast cancer patients; however, some important issues, such as the optimisation of the technique for the intraoperative identification of the sN, t...

Full description

Saved in:
Bibliographic Details
Published in:Journal of surgical oncology 2004-03, Vol.85 (3), p.102-111
Main Authors: Gipponi, Marco, Bassetti, Chiara, Canavese, Giuseppe, Catturich, Alessandra, Di Somma, Carmine, Vecchio, Carlo, Nicolò, Guido, Schenone, Federico, Tomei, Daniela, Cafiero, Ferdinando
Format: Article
Language:English
Subjects:
Adult
Aged
Axilla - surgery
breast cancer
Breast Neoplasms - pathology
Breast Neoplasms - surgery
Clinical Protocols - standards
Female
Frozen Sections
Humans
Lymph Node Excision
Lymph Nodes - pathology
Lymphatic Metastasis
Middle Aged
Neoplasm Invasiveness
Neoplasm Staging
Predictive Value of Tests
Sensitivity and Specificity
sentinel lymph node
Sentinel Lymph Node Biopsy
therapeutic planning
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Background and Objectives Literature review suggests that the sentinel lymph node (sN) represents a reliable predictor of axillary lymph node status in breast cancer patients; however, some important issues, such as the optimisation of the technique for the intraoperative identification of the sN, the role of intraoperative frozen section examination of the sN, and the clinical implications of sN metastasis as regards the surgical management of the axilla, still require further confirmation. The authors aimed (1) to assess the feasibility of sN identification with a combined approach (vital blue dye lymphatic mapping and radioguided surgery, RGS) and the specific contribution of either techniques to the detection of the sN, (2) to determine the accuracy and usefulness of intraoperative frozen section examination of the sN in order to perform a one‐stage surgical procedure, and (3) to define how the sN might modulate the therapeutic planning in different stages of disease. Materials and Methods From October 1997 to June 2001, 334 patients with early‐stage (T1–2 N0 M0) invasive mammary carcinoma underwent sN biopsy; the average age of patients was 61.5 years (range, 39–75 years). In a subset of 153 patients, both vital blue dye (Patent Blue‐V) lymphatic mapping and RGS were used to identify the sN, and the relative contribution of each of the two techniques was assessed. Results In the whole group, the sN was identified in 326 of 334 patients (97.6%), and 105 of 326 patients (37.3%) had positive axillary lymph nodes (pN+). In 9 of 105 pN+ patients, the definitive histologic examination of the sN did not show metastases but these were detected in non‐sN, thus giving an 8.6% false‐negative rate, a negative predictive value of 94.5% (156/165), and an accuracy of 96.5% (252/261). As regards the specific contribution of the two different techniques used in the identification of the sN, the detection rate was 73.8% (113/153) with Patent Blue‐V alone, 94.1% (144/153) with RGS alone, and 98.7% (151/153) with Patent Blue‐V combined with RGS (P 
ISSN:0022-4790
1096-9098
DOI:10.1002/jso.20022