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Sentinel lymph node biopsy during prophylactic mastectomy: is there a role?
Pamela W Bunting1, Amy E Cyr, Feng Gao
1Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
Journal of Surgical Oncology
|February 19, 2014
Summary
Routine sentinel lymph node biopsy (SLNB) during prophylactic mastectomy (PM) is not routinely justified. Occult breast malignancies were found in 3.2% of PMs, with only 1.1% of sentinel lymph nodes (SLNs) testing positive.
Area of Science:
- Oncology
- Surgical Oncology
- Breast Surgery
Background:
- Prophylactic mastectomy (PM) is a surgical option for high-risk individuals.
- Sentinel lymph node biopsy (SLNB) is often performed concurrently with PM.
- The utility of SLNB in the context of PM requires evaluation.
Purpose of the Study:
- To determine the incidence of occult breast malignancy in PM specimens.
- To assess the rate of positive sentinel lymph nodes (SLNs) in patients undergoing PM.
- To evaluate the necessity of routine SLNB during PM.
Main Methods:
- Retrospective review of a database of patients who underwent PM with SLNB.
- Descriptive statistical analysis of collected data.
- Statistical significance set at P < 0.05.
Main Results:
- 15 (3.2%) occult breast malignancies were identified in 467 PM specimens.
- 6 invasive cancers were T1 stage.
- 5 sentinel lymph nodes (SLNs) were positive (1.1%), all in patients with a history or new diagnosis of breast cancer.
- Only one patient with a positive SLN had an occult malignancy in the PM specimen.
Conclusions:
- The incidence of occult malignancy in PM specimens is 3.2%.
- The rate of positive SLNs is low at 1.1%.
- Routine SLNB during PM is not warranted due to low yield and associated morbidity.
