Treatment implications of a positive sentinel lymph node biopsy for patients with early-stage breast carcinoma

Chua, Boon, Ung, Owen, Taylor, Richard, Bilous, Michael, Salisbury, Elizabeth and Boyages, John (2001) Treatment implications of a positive sentinel lymph node biopsy for patients with early-stage breast carcinoma. Cancer, 92 7: 1769-1774. doi:10.1002/1097-0142(20011001)92:7<1769::AID-CNCR1692>3.0.CO;2-6


Author Chua, Boon
Ung, Owen
Taylor, Richard
Bilous, Michael
Salisbury, Elizabeth
Boyages, John
Title Treatment implications of a positive sentinel lymph node biopsy for patients with early-stage breast carcinoma
Journal name Cancer   Check publisher's open access policy
ISSN 0008-543X
1097-0142
Publication date 2001-10-01
Sub-type Article (original research)
DOI 10.1002/1097-0142(20011001)92:7<1769::AID-CNCR1692>3.0.CO;2-6
Volume 92
Issue 7
Start page 1769
End page 1774
Total pages 6
Place of publication New York
Publisher John Wiley & Sons Inc
Language eng
Subject 1103 Clinical Sciences
1112 Oncology and Carcinogenesis
Abstract BACKGROUND. Sentinel lymph node (SLN) mapping and biopsy is emerging as an alternative to axillary lymph node dissection (ALND) in determining the lymph node status of patients with early-stage breast carcinoma. The hypothesis of the technique is that the SLN is the first lymph node in the regional lymphatic basin that drains the primary tumor. Non-SLN (NSLN) metastasis in the axilla is unlikely if the axillary SLN shows no tumor involvement, and, thus, further axillary interference may be avoided. However, the optimal treatment of the axilla in which an SLN metastasis is found requires ongoing evaluation. The objectives of this study were to evaluate the predictors for NSLN metastasis in the presence of a tumor-involved axillary SLN and to examine the treatment implications for patients with early-stage breast carcinoma. METHODS. Between June 1998 and May 2000, 167 patients participated in the pilot study of SLN mapping and biopsy at Westmead Hospital. SLNs were identified successfully and biopsied in 140 axillae. All study patients also underwent ALND. The incidence of NSLN metastasis in the 51 patients with a SLN metastasis was correlated with clinical and pathologic characteristics. RESULTS. Of 51 patients with a positive SLN, 24 patients (47%) had NSLN metastases. The primary tumor size was the only significant predictor for NSLN involvement. NSLN metastasis occurred in 25% of patients (95% confidence interval [95%CI], 10-47%) with a primary tumor size less than or equal to 20 mm and in 67% of patients (95%CI, 46-83%) with a primary tumor size > 20 mm (P = 0.005). The size of the SLN metastasis was not associated significantly with NSLN involvement. Three of 7 patients (43%) with an SLN micrometastasis (< 1 mm) had NSLN involvement compared with 38 of 44 patients (48%) with an SLN macrometastasis (greater than or equal to 1 mm). CONCLUSIONS. The current study did not identify a subgroup of SLN positive patients in whom the incidence of NSLN involvement was low enough to warrant no further axillary interference. At present, a full axillary dissection should be performed in patients with a positive SLN. (C) 2001 American Cancer Society.
Keyword Oncology
Breast Carcinoma
Sentinel Lymph Node Biopsy
Lymph Node Metastasis
Axillary Dissection
Postoperative Radiotherapy
Premenopausal Women
Cancer
Chemotherapy
Lymphadenectomy
Multicenter
Metastasis
Validation
Survival
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Unknown

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Public Health Publications
 
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Created: Mon, 13 Aug 2007, 22:35:40 EST