Sentinel lymph node biopsy in breast cancer

Objectives:

To report our experience in sentinel lymph node biopsy (SLNB) in early breast cancer.

Methods:

This is a retrospective study conducted at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia between January 2005 and December 2014. There were 120 patients who underwent SLNB with frozen section examination. Data collected included the characteristics of patients, index tumor, and sentinel node (SN), SLNB results, axillary recurrence rate and SLNB morbidity.

Results:

There were 120 patients who had 123 cancers. Sentinel node was identified in 117 patients having 120 tumors (97.6% success rate). No SN was found intraoperatively in 3 patients. Frozen section results showed that 95 patients were SN negative, those patients had no immediate axillary lymph node dissection (ALND), whereas 25 patients were SN positive and subsequently had immediate ALND. Upon further examination of the 95 negative SN’s by hematoxylin & eosin (H&E) and immunohistochemical staining for doubtful H&E cases, 10 turned out to have micrometastases (6 had delayed ALND and 4 had no further axillary surgery). Median follow up of patients was 35.5 months and the mean was 38.8 months. There was one axillary recurrence observed in the SN negative group. The morbidity of SLNB was minimal.

Conclusion:

The obtainable results from our local experience in SLNB in breast cancer, concur with that seen in published similar literature in particular the axillary failure rate. Sentinel lymph node biopsy resulted in minimal morbidity.Breast cancer (BC) is the top cancer in women both in the developed and developing world.1 In the USA, nearly 230,000 BCs are diagnosed annually.2 The population of Kingdom of Saudi Arabia (KSA) is approximately 30 million, 65% of them are below the age of 30.3 In KSA, the total number of patients diagnosed to have BC in the year 2010 was 1,473 patients, which constituted 27.4% of all newly diagnosed female cancers in the year 2010. The Age Standardized Rate was 24.9/100,000 for female population. The median age at diagnosis was 49 years. More than half of BC patients in KSA presented with locoregional or distant disease.4 In KSA, there is no national screening program for BC and the Saudi Cancer Registry does not include ductal carcinoma in situ (DCIS) cases in their capture form, which may explain the low number of DCIS cases reported from local centers. It is clear that, KSA is among countries with low disease burden, but it is expected that this burden will increase in the years to come.5 Axillary lymph node status is considered the most important prognostic factor for patients with BC, and it participates largely in the decision regarding subsequent adjuvant systemic treatment.6,7 Axillary lymph node dissection (ALND) for patients with BC was introduced more than 200 years ago for staging and local control.8,9 It is associated with an increase risk of adverse outcomes, including lymphedema in 14% of cases, limited shoulder motion in 28% of the cases and neuropathic pain in 31% of the cases.10 The therapeutic advantage of removing negative nodes with respect to axillary control and survival remains questionable.11-14 At the present time, most BC patients receive some sort of adjuvant systemic therapy irrespective of their lymph node status.15 Based on that, minimally invasive procedures for staging the axilla have been introduced. Sentinel lymph node biopsy (SLNB) in BC, a minimally invasive procedure, was first described in 1994.16 Since then, it has been widely practiced with a wide literature to support its reliability for ascertaining the status of the axillary lymph nodes. Currently, SLNB is accepted as the standard of care for axillary staging in early BC.17-19 In this paper, we are documenting the beginning, development, results and follow up of patients who underwent SLNB for BC at King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia.