Should Sonographic Abnormal Axillary Lymph Nodes Be Excised in Sentinel Node Biopsy of Breast Cancer?

In sentinel node biopsy (SNB) procedure for breast cancer patient, whether the abnormal node was excised is uncertain. The impact of abnormal node on the accuracy of SNB results is unknown.

In this prospective study, breast cancer patients with sonographically abnormal axillary lymph nodes (SAALNs) and negative FNAC results were eligible. Before the SNB operation, a localization wire was placed at the SAALN by ultrasound guidance. In the SNB operation, the wire-localized nodes (WLNs) and radioactive nodes were excised and labeled separately for pathological examination.

In total, 213 WLNs, 169 (79.3%) were sentinel nodes (SNs) and 44 (20.7%) were non-SNs. 79 (37.1%) patients had positive SNs and 63 (29.6%) patients had positive WLNs both identified by pathological examination. 80 (37.6%) patients had positive lymph nodes whether it was SNs or WLNs. Omission diagnosis rate of SNB was 1.3% (1/80). Three axillary recurrence events (3/133, 2.3%) occurred in SN and WLN both negative patients at a median follow-up time of 132 months.

Performing SNB by excising the SAALNs with negative FNAC simultaneously in breast cancer patients could reduce the omission diagnosis rate marginally, and the risk of axillary local recurrence is low.