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Related Experiment Videos

Are 3 sentinel nodes sufficient?

Anees B Chagpar1, Charles R Scoggins, Robert C G Martin

  • 1Department of Surgery, University of Louisville, Louisville, KY, USA. anees.chagpar@nortonhealthcare.org

Archives of Surgery (Chicago, Ill. : 1960)
|May 23, 2007
PubMed
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Limiting sentinel lymph node biopsy (SLNB) to 3 nodes increases the false-negative rate (FNR), potentially missing cancer spread. Surgeons should remove all identified nodes for accurate staging.

Area of Science:

  • Oncology
  • Surgical Pathology
  • Cancer Staging

Background:

  • Sentinel lymph node biopsy (SLNB) is a standard procedure for staging breast cancer.
  • Recent proposals suggest limiting SLNB to 3 nodes to potentially reduce operative time and cost.
  • The adequacy of a 3-node SLNB strategy requires further investigation regarding its impact on diagnostic accuracy.

Purpose of the Study:

  • To evaluate the false-negative rate (FNR) associated with a strategy of limiting sentinel lymph node biopsy (SLNB) to 3 nodes.
  • To compare the FNR of a 3-node SLNB strategy with the FNR when more than 3 nodes are removed.

Main Methods:

  • A multicenter prospective study involving 4131 patients undergoing SLNB followed by completion axillary node dissection.
  • Data collected included the number of sentinel lymph nodes (SLNs) identified and removed, and the status of lymph node dissection.

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  • The primary outcome measure was the FNR associated with a 3-node SLNB strategy.

    • Main Results:

    • An SLN was identified in 94.0% of patients; the median number of SLNs removed was 2.
    • The overall FNR for SLNB in this study was 7.7%.
    • Limiting SLNB to the first 3 nodes would have resulted in an FNR of 10.3%, a significant increase compared to removing more nodes (P = .005). The FNR increased as fewer SLNs were removed (P<.001).

    Conclusions:

    • A strategy of removing only 3 sentinel lymph nodes (SLNs) is not recommended due to a substantially increased false-negative rate.
    • This increased FNR may lead to understaging of nodal metastasis.
    • Comprehensive SLNB, including removal of all identified positive nodes, is crucial for accurate cancer staging.