Sentinel node biopsy and axillary node sampling in women with breast cancer undergoing breast conserving surgery. Preliminary results of a prospective study

Background: Axillary dissection still represents the most accurate means of determining axillary lymph node status in patients with breast cancer (BC), but at the expense of significant morbidity. However, sentinel node biopsy (SNB) technique does not reach 100% sensitivity in detecting (or excluding) axillary node metastases, especially in the presence of unsuspected micrometastases. The aim of this study was to asses the accuracy of axillary node sampling (ALNS) in addition to SNB in patients with BC undergoing curative surgery. Patients and Methods: Sixty-seven consecutive women (median age 54 years, range 28-68 years) with pT1 primary BC undergoing breast conserving surgery were enrolled in the study. Patients were prospectively randomizes to undergo SNB alone (Group A, 35 patients) or ALNS in addition to SNB (Group B, 32 patients), followed by level I-II axillary dissection. In all cases, a combined method using radioisotope and blue dye was used for SNB. Patients with positive SNB were excluded. Results: The age of the patients (54.8±8.2 vs. 54.1±9.2, p=0.74) and the number of the removed nodes (median 19, range 16-25 in each Group) did not differ significantly (p=NS) between Groups. A median of 7 lymph nodes (range 6-9) was removed in Group B patients. In all patients intraoperative frozen section examination did not show positive nodes, whilst final histopathology showed micometastases in six (8.9%) patients. The sensitivity of SNB technique alone (false-negative rate: 14.3%) and SNB in addition to ALNS (false-negative rate: 3.1%) was 85.7% and 96.9%, respectively. Conclusions: SNB alone in inaccurate in detecting axillary node micrometastases, and ALNS should be performed in all patients with macroscopically suspicious nodes and negative SNB.