Conservation of the axilla: an audit of sentinel lymph node biopsy after a new start

Four hundred twenty-eight patients with a diagnosis of breast cancer were assessed. All patients underwent axillary ultrasonographic scanning preoperatively or at the time of initial breast imaging. Suspicious axillary glands underwent core needle biopsy under ultrasonographic guidance.

The majority of patients were in the age range of 40 to 80 years. Sentinel lymph node biopsy (SLNB) was performed in 360 patients.

Sixty-eight patients had axillary clearance as a first axillary procedure. Of these patients, 55 had a preoperative diagnosis of a positive axillary gland in the axilla on ultrasonographically guided core needle biopsy, and 13 had clinically palpable axillary lymph glands. Seventy-one patients (21%) had a positive sentinel lymph node on histopathologic examination after hematoxylin and eosin (H & E) staining. Preoperative scans of the axilla had been reported as normal in these patients. In 68 patients, further axillary surgery was performed to clear the axilla; 24 of these patients (35%) had more positive glands in the axilla. In 44 patients (65%) the sentinel lymph glands were the only positive glands. Of 224 patients with a tumor size ≤ 20 mm, there were 30 patients (14%) who had a positive sentinel node. Of 136 patients with a tumor size > 20 mm, there were 41 patients (33%) with positive sentinel nodes.

Sentinel lymph node biopsy in breast cancer allowed conservation of the axilla in 80% (289/360) of patients with negative sentinel lymph nodes in this study. Preoperative ultrasonographically guided core needle biopsy reduced the need for a second operation in 55 patients (13%).