Sentinel lymph node biopsy in patients with male breast carcinoma

BACKGROUND: Sentinel lymph node biopsy (SLNB) is now a widely implemented technique for evaluating the axilla in women with early stage breast carcinoma. Men who develop breast carcinoma are at similar risk as their female counterparts of developing the morbidities related to axillary dissection. SLNB is aimed at preventing these morbidities. In this study, the authors evaluated the role of SLNB in the treatment of men with early stage breast carcinoma. METHODS: Among the 1692 patients who underwent SLNB at the Memorial Sloan-Kettering Cancer Center, 16 men with breast carcinoma were identified. The charts and records of these 16 patients were reviewed retrospectively. RESULTS: The mean patient age was 57.2 years. The mean tumor size was 1.3 cm. In 15 of 16 patients (93.75%) and in all patients with T1 tumors, one or more sentinel lymph nodes were successfully identified. SLNB failed in one patient, who had a T2 tumor (3 cm). Ten of the 15 patients had negative sentinel lymph nodes (66.7%). Four of these patients had no additional lymph nodes removed, whereas six patients had additional lymph nodes removed, all of which were negative. Two patients (13.3%) had positive sentinel lymph nodes on frozen-section analysis and underwent immediate completion axillary dissection: Both had additional positive lymph nodes. Three patients (20.0%) had positive sentinel lymph nodes on further sectioning or immunohistochemistry, and two patients underwent completion axillary dissection: Neither patient had additional positive lymph nodes. The third patient had one immunohistochemically positive lymph node and did not undergo completion axillary dissection. CONCLUSIONS: SLNB for patients with breast carcinoma was as successful in men as it has been shown to be in women and may be offered as a management option to men with early stage breast carcinoma by surgeons who are experienced with the technique.     

前哨淋巴结活检在早期乳腺癌患者腋窝管理中的研究进展

传统的观点认为腋窝淋巴结清扫(axillary lymph node dissection,ALND)是前哨淋巴结(sentinellymph node,SLN)阳性乳腺癌患者的标准治疗方法,而ALND容易引起上肢水肿、功能障碍等术后并发症,影响患者生活质量.近几年研究显示,对于SLN阳性的早期乳腺癌,并非所有患者都需...     

乳腺癌新辅助化疗后前哨淋巴结活检的临床意义

目的探讨新辅助化疗后乳腺癌前哨淋巴结活检的可行性。方法对57例行^99Tc联合亚甲蓝示踪前哨淋巴结活检术和腋窝淋巴结清扫术乳腺癌患者的资料进行分析,其中31例ⅡB、Ⅲ期患者先行2～3个疗程新辅助化疗后再行前哨淋巴结活检及腋窝淋巴结清扫术,另26例Ⅰ、Ⅱ期患者直接行前哨淋巴结活检及腋窝淋巴结清扫术。结果新辅助化疗组和非新辅助化疗组平均腋窝淋巴结数、前哨淋巴结（sentinel lymph node,SLN）数、SLN检出率、SLN假阴性率均无显著差异（P均〉0．05）。新辅助化疗纽化疗前临床分期在N2以上者,SLN检出率均显著下降（P〈0．05）。结论新辅助化疗后前哨淋巴结活检能准确预测腋窝淋巴结的状况。化疗前的N分期是SLNB检出率的影响因素。     

早期乳腺癌腋窝亚LevelⅡ淋巴结清扫的初步研究

目的:探索基层医院早期乳腺癌腋窝淋巴结外科处理的适宜方法。方法:对9例符合研究条件的病例先美兰染色(meythylene blue staining)实施前哨淋巴结活检(sentinel lymph node biopsy,SLNB),再补充实施腋窝淋巴结清扫术(axillary lymph node dissection,ALND);ALND术中显露腋静脉,以腋静脉下2cm为界缝线标记,术后将标本从缝线处分离,对淋巴结进行分组取材,将前哨淋巴结、腋静脉下2cm内淋巴结(亚levelⅡ淋巴结)、腋窝其余淋巴结(其余淋巴结)分组送病理检查,观察各组淋巴结数量及肿瘤细胞腋淋巴结转移规律。结果:找到前哨淋巴结6例;5例前哨淋巴结、亚levelⅡ淋巴结、其余淋巴结均为阴性;1例前哨淋巴结、亚levelⅡ淋巴结、其余淋巴结均为阳性;另有1例患者前哨淋巴结未找到,而亚levelⅡ淋巴结检出阳性。结论:基层医院对于早期乳腺癌腋窝淋巴结清扫,可以用美兰染色行前哨淋巴结活检,若前哨淋巴结阳性或未找到前哨淋巴结,行ALND;若前哨淋巴结阴性,行亚levelⅡ淋巴结清扫。     

Sentinel lymph node biopsy in breast cancer patients after neoadjuvant chemotherapy

BACKGROUND AND OBJECTIVES: Sentinel lymph node biopsy (SLNB) is an accurate method for axillary staging in patients with early breast cancer. The aim of this study was to evaluate the accuracy and the feasibility of SLNB in breast cancer patients who had received preoperative (neoadjuvant) chemotherapy. METHODS: Patients with advanced breast cancer stage II or III who were treated with neoadjuvant chemotherapy were included in the study. Sentinel lymph node (SLN) identification and biopsy was attempted and performed, and axillary lymph node dissection (ALND) was performed in the same surgical procedure after SLNB. The histopathologic examination of the SLNs and the dissected axillary lymph nodes was performed and nodal status was compared. RESULTS: Thirty patients were included in the study. After peritumoural injection of technetium-99m labelled human albumin and subareolar subcutaneous injection of blue dye, the SLNs could be identified in 26/30 patients (identification rate 86.7%). In 4/30 patients (13.3%) SLNs could not be identified. In 25/26 patients (96.2%) SLNs accurately predicted the axillary status. Eleven patients had negative SLNs and negative nodes in ALND. Six patients had positive SLNs and positive nodes in ALND. In eight patients SLNs only were positive and nodes in ALND were negative. One patient had a false-negative SLNB, calculating a false-negative rate of 6.7% (1/15). CONCLUSIONS: SLNB is a well introduced technique for axillary staging in patients with early breast cancer. The accuracy of SLNB after neoadjuvant chemotherapy is similar to patients with primary surgery. SLNB could be an alternative to ALND in a subgroup of patients after neoadjuvant chemotherapy, and therefore could reduce morbidity due to surgery in those patients. Due to small numbers of patients, further evaluation in this subset of patients is required.     

乳腺癌前哨淋巴结活检研究进展

近年来,乳腺癌的发病率越来越高,乳腺癌治疗方式也在不断改进,但手术仍然是早期乳腺癌治疗的主要手段。对于早期乳腺癌,前哨淋巴结活检术（sentinel lymph node biopsy,SLNB）是一种安全、精确的手术方式,已逐渐替代腋窝淋巴结清扫术（axillary lymph node dissection,ALND）成为早期乳腺癌治疗的标准术式。随着研究的深入,SLNB的应用范围更广,术后生活质量显著改善,但其操作尚需要进一步统一规范。在前哨淋巴结微转移、宏转移、前哨淋巴结活检阳性的老年患者以及新辅助化疗的前哨淋巴结活检等方面尚未达成共识,还需要更多大型多中心前瞻性的随机试验来进一步论证。     

Comparing Early-Stage Breast Cancer Patients with Sentinel Lymph Node Metastasis with and without Completion Axillary Lymph Node Dissection: A Systematic Review and Meta-Analysis

Background: Currently, the standard method for staging and treatment of axillary lymph nodes for early-stage breast cancer is sentinel lymph node biopsy (SLNB), while axillary lymph node dissection (ALND) is used in cases with palpable axillary lymph nodes or positive SLNB cases. The aim of this review was to compare overall survival (OS), disease-free survival (DFS), and axillary recurrence in early-stage breast cancer patients underwent SLNB or SLNB and completion ALND. Methods: The databases of PubMed, Scopus, and Cochrane Library were searched using the key words of “breast cancer”, “axillary lymph node dissection”, and “sentinel lymph node dissection”. In addition, other sources were searched for ongoing studies (i.e., clinicaltrials.gov). The clinical trials were evaluated based on the Jadad quality criteria, and cohort studies were evaluated according to the STROBE criteria. At the end of the search, the articles were screened independently by two reviewers to check their eligibility to be included in the study. Afterwards, the data were extracted independently by two researchers. Results: After searching the databases, 169 papers were retrieved. However, after removing the duplicates and studying the titles and abstracts of these papers, only ten ones underwent further investigation. After reading full-text of each article, four studies were finalized. Following a manual search, 27 papers were entered into the study for the final evaluation, 11 of which were included in the meta-analysis based on the inclusion and exclusion criteria. The findings showed no significant differences in OS, DFS, and axillary recurrence in early-stage breast cancer patients underwent SLNB or SLNB and completion ALND. Conclusion: The findings did not confirm that ALND improved OS, DFS, and axillary recurrence in patients who were clinically node-negative and positive SLNB.     

The sentinel node biopsy after previous breast surgery: preliminary results on 543 patients treated at the European Institute of Oncology

Background. Sentinel lymph node biopsy (SLNB) is an accurate alternative to complete axillary lymph node dissection (ALND) in clinically node-negative breast cancer patients. A previous breast biopsy has been considered a relative contraindication to SLNB. We examined the accuracy of SLNB by following the axillary relapses after the procedure in patients who had undergone a breast biopsy before SLNB.Patients and Methods. Up to December 2003, 4351 patients with the diagnosis of invasive breast cancer underwent SLNB at the European Institute of Oncology. Already, 543 of these patients had undergone a breast biopsy; from June 1997 to January 2004, these patients received SLNB by lymphoscintigraphy performed on the biopsy area. We followed these patients with a clinical assessment every 6 months and instrumental examinations every year, particularly focusing on the research of axillary relapse of disease.Results. In 70.4% of cases, the sentinel node was negative, and only three cases underwent further axillary dissection. The sentinel node was identified in 99% of cases and this was the only positive node in 61.5% of cases with positive axillary nodes. The median follow-up was 2 years; 4 nodal recurrences were observed: 3 axillary lymph node relapses and 1 loco-regional.Conclusions. SLNB accuracy after a previous breast biopsy is comparable with the results obtained in validation studies. SLNB after a previous breast biopsy can be considered a standard procedure. Lymphoscintigraphy identifies the sentinel node in 99% of patients.     

1枚前哨淋巴结阳性早期乳腺癌保腋窝的可行性分析

目的探讨1枚前哨淋巴结（sentinel lymph node,SLN）阳性的早期乳腺癌患者保腋窝（omitting axillary dissection,OAD）的可行性。方法用美蓝作为示踪剂先行乳腺癌前哨淋巴结活检术（sentinel lymph node biopsy,SLNB）,根据快速冰冻病理结果分为SLN阴性组与1枚SLN阳性组,随后两组均行常规腋窝淋巴结清扫（axillary lymph node dissection,ALND）以解剖出非前哨淋巴结（non—sentinellymphnode,NSLN）,比较两组间NSLN的阳性率。结果SLN阴性组30例,1例NSLN阳性,阳性率为3．3％,准确性为96．7％（29／30）;1枚SLN阳性组30例,仅3例NSLN阳性,阳性率为10．0％;两组阳性率差异无统计学意义（X^2=1．071,P=0．612）。全组随访1～48个月,均无区域淋巴结复发。结论1枚SLN阳性的早期乳腺癌患者可考虑OAD。     

Is Necessary Intraoprative Frozen Section In Sentinel Lymph Node Biopsy For Breast Cancer Patients?

Background: Improvements in the process of staging and surgical treatment of axillary lymph nodes in recent years, have led to the use of intra operative frozen section pathology to examine the sentinel lymph node biopsy in breast cancer patients. Materials and Methods: we evaluated the results of the Sentinel biopsy in 102 patients with early stage breast cancer, which were negative clinical lymph nodes, and analyzing the true positive and false negative rate, diagnostic accuracy of frozen section lymph node biopsy. It also studied the factors affecting the sentinel and non-sentinel lymph nodes in patients treated by axillary lymph dissection. Results: In this study, we investigated 102 patients’ stage 1and 2 breast cancer with clinical negative axillary lymph node and candidates for sentinel lymph node biopsy, were placed under investigation. 15.7 % of the real positive results of sentinel and 62.7 % of the real negative and 2 % false positives and 20.9 % false negative results and% 78. 4 diagnostic accuracy, has been frozen section. Among the patients who were initially or delayed in the axillary dissection, 37% had more than two lymph nodes. While in general, 16.7% of patients had a need for axillary lymph node dissection based on z11 criteria. Lymph-vascular invasion was a major contributor to lentil involvement in Sentinel and non-Sentinel nodes. Conclusion: Frozen section pathology during the operation of sentinel lymph node biopsy has been initiated to prevent the need for a reoperation in early stage breast cancer patients. However, due to low tumor burden in patients who are candidates for this procedure, and the constraints in the initial sections and their false negative results, also the removal of frozen section will not have an effect on the rate of increasing reoperation and can be effective in reducing the time and cost of surgery.     

200 Sentinel lymph node biopsies without axillary lymph node dissection -- no axillary recurrences after a 3-year follow-up

The aim of this study is to evaluate the rate of axillary recurrences in sentinel lymph node (SLN)-negative breast cancer patients after sentinel lymph node biopsy (SLNB) alone without further axillary lymph node dissection (ALND). Between May 1999 and February 2002, 333 consecutive patients with primary invasive breast cancer up to 4 cm and clinically negative axillae were entered into this prospective study. Sentinel lymph nodes were identified using the combined method with blue dye (Patent blue V) and technetium 99m-labelled albumin (Nanocoll). Sentinel lymph nodes were examined by frozen sections, standard haematoxylin and eosin staining and immunohistochemistry staining. In SLN-positive patients, ALND was performed. Sentinel lymph node-negative patients had no further ALND. The SLN identification rate was 98.5% (328 out of 333). In all, 128 out of 328 (39.0%) patients had positive SLNs and complete ALND. A total of 200 out of 328 (61.0%) patients were SLN negative and had no further ALND. The mean tumour size of SLN-negative patients was 16.5 mm. The mean number of SLNs removed was 2.1 per patient. There were no local or axillary recurrences at a median follow-up of 36 months. The absence of axillary recurrences after SLNB without ALND in SLN-negative breast cancer patients supports the hypothesis that SLNB is accurate and safe while providing less surgical morbidity than ALND. Short-term results are very promising that SLNB without ALND in SLN-negative patients is an excellent procedure for axillary staging in a cohort of breast cancer patients with small tumours.     

美蓝在乳腺癌前哨淋巴结活检中的临床价值

目的探讨美蓝在乳腺癌前哨淋巴结活检中的临床价值。方法将1%美蓝2ml注入活检腔外上方的皮下及乳腺组织内,然后行Auchincloss仿根治术,依淋巴管走向找到蓝染淋巴结定为SLN,若此时未找到待腋窝清扫结束后,再在标本中寻找,蓝染者为SLN,余为非SLN,分别送病理检查。结果前哨淋巴结检出率为87.9%(95/108),SLN预测腋窝状况的准确率为95.7%(91/95),假阴性率为6.5%(4/62),无假阳性者。未检出者13例,其中4例为假阴性,均属跳跃式转移。前哨淋巴结转移阳性率(34.6%,33/95)和阴性率(65.3%,62/95),与全腋淋巴结转移阳性率(39.8%,43/108)和阴性率(60.2%,65/108)比较,均无显著性差异(P>0.05)。结论美蓝前哨淋巴结活检可以准确预测乳腺癌患者的腋淋巴结状态。     

早期乳腺癌腋窝亚LevelⅡ淋巴结清扫的初步研究

目的：探索基层医院早期乳腺癌腋窝淋巴结外科处理的适宜方法。方法：对9例符合研究条件的病例先美兰染色（meythylene blue staining）实施前哨淋巴结活检（sentinel lymph node biopsy,SLNB）,再补充实施腋窝淋巴结清扫术（axillary lymph node dissection,ALND）;ALND术中显露腋静脉,以腋静脉下2cm为界缝线标记,术后将标本从缝线处分离,对淋巴结进行分组取材,将前哨淋巴结、腋静脉下2cm内淋巴结（亚levelⅡ淋巴结）、腋窝其余淋巴结（其余淋巴结）分组送病理检查,观察各组淋巴结数量及肿瘤细胞腋淋巴结转移规律。结果：找到前哨淋巴结6例;5例前哨淋巴结、亚levelⅡ淋巴结、其余淋巴结均为阴性;1例前哨淋巴结、亚levelⅡ淋巴结、其余淋巴结均为阳性;另有1例患者前哨淋巴结未找到,而亚levelⅡ淋巴结检出阳性。结论：基层医院对于早期乳腺癌腋窝淋巴结清扫,可以用美兰染色行前哨淋巴结活检,若前哨淋巴结阳性或未找到前哨淋巴结,行ALND;若前哨淋巴结阴性,行亚levelⅡ淋巴结清扫。     

前哨淋巴结时代乳腺癌的精准区域处理：演进与展望

区域淋巴结状况是乳腺癌重要的预后指标之一,可以指导分期和辅助治疗策略的制定。近30年来乳腺癌前哨淋巴结活检术（sentinel lymph node biopsy,SLNB）研究发展迅速,循证医学Ⅰ类证据支持其为临床腋窝淋巴结阴性早期乳腺癌患者安全、有效的腋窝分期技术,前哨淋巴结阴性及低肿瘤负荷患者SLNB替代腋窝淋巴结清扫术后腋窝复发风险和并发症极低。乳腺癌局部区域控制新理念——应该综合考虑远处转移风险、全身治疗效果与不良反应以及局部区域治疗（手术/放疗）效果与不良反应——推动了SLNB适应人群不断扩展,新辅助治疗与SLNB、内乳SLNB将进一步促进区域淋巴结处理降阶梯,豁免腋窝手术临床研究值得期待。SLNB标志着乳腺癌区域淋巴结迈入微创化精准诊疗时代。本文就前哨淋巴结时代乳腺癌的精准区域处理的演进过程和最新进展进行总结,以期为广大临床工作者提供参考。     

前哨淋巴结活检对乳腺癌腋窝淋巴结转移状况的预测价值

目的探讨前哨淋巴结活检(SLNB)对乳腺癌腋窝淋巴结转移状况的预测价值。方法以36例体检无腋窝淋巴结转移的乳腺癌患者为研究对象，用美蓝皮下注射染色法定位前哨淋巴结(SLY)，行SLNB，以病理检查结果计算SLNB的成功率及假阴性率、假阳性率、准确性、灵敏度、特异度、阳性符合率、阴性符合率、阳性结果预测值、阴性结果预测值。结果36例患者行SLNB，成功率为97．2％，灵敏度为92．9％。特异度为100％，假阴性率为7．7％，假阳性率为O％，准确率为95．8％，阳性符合率为92．3％；阴性符合率为95．7％，阳性结果预测值为100％，阴性结果预测值为93．9％。结论美蓝皮下注射染色法行SLNB有很高的成功率，SLNB能够准确地预测乳腺癌腋窝淋巴结转移状况。     

早期乳腺癌前哨淋巴结活检替代腋窝淋巴结清扫的临床应用研究

目的 对前哨淋巴结活检(sentinel lymph node biopsy,SLNB)替代腋窝淋巴结清扫(axillary lymph node dis-section,ALND)在早期乳腺癌患者中的应用以及安全性研究及探讨.方法 回顾性分析行SLNB和ALND手术的503例早期乳腺癌病例,对患者住院时间、拔管时间及住院费用进行对比,以及对患者上肢并发症、腋窝局部复发及远处转移情况进行随访,随访至2016年06月,中位随访时间为32(6 ～52)个月.结果 在住院时间、拔管时间、住院费用以及上肢并发症方面,SLNB组明显优于ALND组,差异有统计学意义,而在腋窝局部复发及远处转移情况方面两组无统计学意义.结论 在SLN阴性早期乳腺癌中,SLNB与ALND可以取得相同的疗效,而且,SLNB与ALND相比,手术创伤小,麻木疼痛、肩关节活动受限等术后并发症明显减少,且可缩短患者住院时间,减轻患者的经济负担.     

Recurrence after sentinel lymph node biopsy with or without axillary lymph node dissection in patients with breast cancer

BACKGROUND: A regional nodal recurrence is a major concern after a sentinel lymph node biopsy (SLNB) alone in patients with breast cancer. In this study we investigated patterns and risk factors of regional nodal recurrence after SLNB alone. PATIENTS AND METHODS: Between January 1999 and March 2005, a series of 1,704 consecutive breast cancer cases in 1,670 patients (34 bilateral breast cancer cases) with clinically negative nodes or suspicious nodes for metastasis who underwent SLNB at a single institute (Saitama Cancer Center) were studied. All 1,704 cases were classified based upon presence or absence of a metastatic lymph node, treated with or without axillary lymph node dissection (ALND). The site of first recurrence was classified as local, regional node, or distant. The regional node recurrences were subclassified as axillary, interpectoral, infraclavicular, supraclavicular, or parasternal. RESULTS: After a median follow-up period of 34 months (range, 2-83 months), first recurrence occurred in local sites in 32 (1.9%) cases, regional nodes in 26 (1.5%) cases, and distant sites in 61 (3.6%) cases. In 1,062 cases with negative nodes treated without ALND and 459 cases with positive nodes treated with ALND, 11 (1.0%) and 15 (3.3%) recurred in regional nodes, respectively, and 4 (0.4%) and 2 (0.6%) recurred in axillary nodes, respectively. Of 822 cases of invasive breast cancer with negative nodes treated with SLNB alone, 10 (1.4%) recurred in regional nodes, and 4 (0.5%) recurred in axillary nodes. In the 10 patients with regional nodal failure, all of the tumors were negative for estrogen receptor (ER) and/or progesterone receptor (PR) and were nuclear grade (NG) 3. CONCLUSIONS: The axillary recurrence rate was low in patients treated with SLNB alone. Omitting ALND is concluded to be safe after adequate SLNB. Risk factors for regional nodal failure after SLNB alone are negative hormone receptor status and high NG.     

染料法前哨淋巴结活检在乳腺癌手术中的应用价值

目的探讨前哨淋巴结活检（SLNB）在乳腺癌手术中的临床应用价值。方法采用亚甲蓝作为示踪染料对乳腺癌开展SLNB，并且对术中冰冻检查前哨淋巴结（SLN）阴性的病例分组施行部分腋窝淋巴结清扫术（PALND）及常规全腋窝淋巴结清扫（TALND），观察术后并发症、生存率等指标并比较分析。结果SLN检出率97．6％，假阴性率14．3％；接受PALND组术后并发症发生率明显低于传统的TALND组，差异有统计学意义（P〈0．05），而总生存率间的差异无统计学意义（P〉0．05）。结论腋区SLNB能准确反映乳腺癌腋窝淋巴转移状态，为临床缩小乳腺癌手术范围和减少术后并发症提供重要参考价值。     

Axillary surgery in breast cancer patients

Surgeons have routinely removed ipsilateral axillary lymph nodes from women with breast cancer for over 100 years. The procedure provides important staging information, enhances regional control of the malignancy and may improve survival. As screening of breast cancer has increased, the mean size of newly diagnosed primary invasive breast cancers has steadily decreased and so has the number of women with lymph node metastases. Recognising that the therapeutic benefit of removing normal nodes may be low, alternatives to the routine level I/II axillary lymph node dissection have been sought. A decade ago sentinel lymph node biopsy (SLNB) was introduced. Because of its high accuracy and relatively low morbidity, this technique is now widely used to identify women with histologically involved nodes prior to the formal axillary node dissection. Specifically, SLNB has allowed surgeons to avoid a formal axillary lymph node biopsy in women with histologically uninvolved sentinel nodes, while identifying women with involved sentinel nodes who derive the most benefit from a completion axillary node dissection. Despite the increasing use of SLNB for initial management of the axilla in women with breast cancer, important questions remain regarding patient selection criteria and optimal surgical methods for performing the biopsy. This article discusses the evolution of axillary node surgery for women with breast cancer.     

Prognosis of breast cancer patients treated with sentinel node biopsy in Japan

BACKGROUND: Sentinel node biopsy predicts accurate pathological nodal staging. The survival of node-negative breast cancer patients should be evaluated between the patients treated with sentinel node biopsy alone and those treated with axillary lymph node dissection. METHODS: Ninety-seven patients with negative axillary nodes underwent sentinel node biopsy immediately followed by axillary lymph node dissection between January 1998 and June 1999 (the ALND group). Since then, if sentinel lymph nodes were negative on the frozen-section diagnosis, 112 patients underwent sentinel node biopsy alone without axillary lymph node dissection between July 1999 and December 2000 (the SNB group). We retrospectively observed the outcome of the two study groups. RESULTS: Median follow-up was 52 months in all patients. Relapse-free survival rates at 3 years in the ALND and SNB groups were 94% and 93%, respectively. Five of the 112 patients in the SNB group had overt axillary metastases. Three of them with axillary metastases alone were treated with delayed axillary lymph node dissection. These three patients have been free of other events for 3 years after local salvage treatment. CONCLUSIONS: Sentinel node biopsy will emerge as a standard method to diagnose axillary nodal staging for clinically node-negative breast cancer patients.