Sentinel Node Biopsy in Breast Cancer Patients with Large or Multifocal Tumors |
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Authors: | Tuomo J Meretoja MD PhD Marjut H Leidenius MD PhD Päivi S Heikkilä MD PhD Heikki Joensuu MD PhD |
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Institution: | (1) Department of Gastrointestinal and General Surgery, Breast Surgery Unit, Helsinki University Central Hospital, Helsinki, Finland;(2) Department of Pathology, Helsinki University Central Hospital, Helsinki, Finland;(3) Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland |
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Abstract: | Background The axillary recurrence (AR) rate after negative sentinel node biopsy (SNB) in patients with high risk of axillary metastases
is largely unknown. The aim of this study was to analyze the risk factors for isolated AR after negative SNB with special
interest in large or multifocal tumors.
Methods A prospective SNB registry was analyzed for 2,408 invasive breast cancer patients operated between 2001 and 2007. No axillary
clearance was performed in 1,309 cases with a negative SNB, including 1,138 small unifocal tumors, 121 small multifocal tumors,
48 large unifocal tumors, and 2 large multifocal tumors.
Results Six (0.5%) isolated AR were observed during a median follow-up of 43 months. Four (0.4%) patients with small unifocal tumors
and two (1.6%) with small multifocal tumors had isolated AR (p = 0.179). None of the patients with large unifocal or multifocal tumors had isolated AR. Instead of tumor size and multifocality,
estrogen receptor negativity (p < 0.001), nuclear grade III (p < 0.001), Her-2 status (p = 0.002), no radiotherapy (p = 0.005), and mastectomy (p = 0.005) were found to be associated with AR.
Conclusions A remarkable proportion of patients with large unifocal tumors and small multifocal tumors may avoid unnecessary AC due to
tumor negative SNB, without an excessive risk of AR. |
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