The clinical significance of micrometastatic breast cancer in sentinel lymph node biopsies

L. M. Roland, I. Gage, T. A. Fleury, C. M. Magnant

Research output: Contribution to journalArticlepeer-review

Abstract

This study was performed to compare the Sentinel lymph node (SLN) pathologic diagnosis with the final axillary lymph node (ALN) evaluation in patients found to have metastatic disease on SLN biopsy. METHOD: A retrospective study of 69 consecutive patients who underwent SLN biopsy during the year 2000. Blue dye and lymphoscintigraphy were used together to localize the sentinel lymph node. Pathology reports were reviewed to identify those patients diagnosed with micrometastatic (≤2mm) disease intraoperatively on frozen section with H&E or postoperatively on permanent section with H&E and pankeratin staining. Final ALN pathologic diagnoses were reviewed and compared to the SLN diagnoses. RESULTS: The SLN was located in 66 (95.6%) patients, and contained tumor in 26 (39.4%) cases. Of those 26 cases, the SLN was positive on frozen section in 14 patients (53.8%) and on permanent section in 12 patients (46.1%). Among the 14 patients with positive SLN on frozen section, 13 of the patients underwent subsequent axillary lymph node dissection (ALND) and 2 patients had one positive additional lymph node. Among the 12 patients with positive SLN on permanent section, 5 (41.6%) were by pankeratin only in a single SLN. and were micrometastatic. The other 7 patients had greater than micrometastatic involvement and were positive by H&E and/or pankeratin. Among the 4 patients with micrometastatic disease undergoing ALND, 50% had additional positive ALN. Among all patients with positive SLNs, the ALND was positive in 15% (4/26). CONCLUSION: The finding of a positive sentinel lymph node on permanent section after a negative frozen section is not uncommon. Therefore, the decision to perform ALND often must be made postoperatively. Since the discovery of additional positive nodes is not a frequent event (15% in this study), ALND as a subsequent procedure has become controversial, especially in the setting of micrometastatic SLN disease. However, in our experience, micrometastatic disease cannot reliably be used to exclude patients from the need for ALND.

Original languageEnglish (US)
Number of pages1
JournalBreast Cancer Research and Treatment
Volume69
Issue number3
StatePublished - Dec 1 2001
Externally publishedYes

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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