Sentinel node biopsy in breast cancer: five years experience from Denmark

Area of Science:

• Oncology
• Surgical Pathology
• Breast Cancer Staging

Background:

• Sentinel lymph node biopsy (SLNB) has been implemented as a routine staging procedure for early breast cancer in Denmark.
• This report details the initial five years of experience with SLNB in Danish breast surgical centers.

Purpose of the Study:

• To evaluate the safety and efficacy of sentinel lymph node biopsy (SLNB) as a standard staging procedure for early breast cancer.
• To assess the rate of axillary surgery avoidance and loco-regional control following SLNB compared to traditional axillary lymph node dissection (ALND).

Main Methods:

• Analysis of data from 14,923 early breast cancer patients diagnosed between 2002 and 2006 in certified Danish centers.
• SLNB was performed in 8,338 patients, with increasing adoption from 43% to 67% during the study period.
• Combination of blue dye and radio colloid was the primary tracer method, with periareolar injection becoming standard.

Main Results:

• SLNB patients were younger with smaller tumors and less advanced disease compared to those undergoing ALND.
• Macrometastases were found in 25% of sentinel nodes, micrometastases in 17%, and isolated tumor cells in 3.2%.
• Lymph node recurrence was higher in node-negative patients staged with SLNB (0.5%) versus ALND (0.2%).

Conclusions:

• Sentinel lymph node biopsy (SLNB) can safely stage two-thirds of early breast cancer patients, allowing avoidance of further axillary surgery in half.
• While loco-regional control is high in node-negative patients staged by SLNB, it appears slightly less effective than ALND.