Journal of Cancer Research and Treatment
ISSN (Print): 2374-1996 ISSN (Online): 2374-2003 Website: Editor-in-chief: Jean Rommelaere
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Journal of Cancer Research and Treatment. 2019, 7(2), 44-47
DOI: 10.12691/jcrt-7-2-2
Open AccessArticle

Does The Tumor Location Affect The Accuracy of Sentinel Lymph Node Biopsy In Breast Cancer? A Single Institute Experience

Rabie Ramadan1 and Ahmed Talha1,

1Department of Surgery, Medical Research Institute, Alexandria University, Egypt

Pub. Date: December 15, 2019

Cite this paper:
Rabie Ramadan and Ahmed Talha. Does The Tumor Location Affect The Accuracy of Sentinel Lymph Node Biopsy In Breast Cancer? A Single Institute Experience. Journal of Cancer Research and Treatment. 2019; 7(2):44-47. doi: 10.12691/jcrt-7-2-2


Background: Sentinel lymph node biopsy (SLNB) can give an idea about the nodal status with high accuracy. Objective: To assess the effect of breast cancer location on SLNB accuracy regarding identification rate (IR), accuracy rate and false negativity rate (FNR). Methods: Breast cancer patients with positive axilla who were scheduled for axillary lymph node dissection (ALND) were included. They were randomly allocated into two groups: Group I (G I) included patients with laterally located breast cancer while Group II (G II) included patients with medially located breast cancer. Four ml of Methylene blue (1%) was injected in the peritumoral tissue. SLNB was taken for histopathological examination while ALND was completed in all cases. SLN IR, FNR and accuracy rate were assessed in both groups. Results: This study included 104 female patients; 63 (60.6%) in GI whereas 41(39.4%) in GII. SLN identification was done successfully in 92% in G I and 87.8% in G II with no significant difference. In G I; Out of the 58 patients in whom SLN was identified; SLN was positive in 54 (93.1%) cases and negative in 4(6.9%) cases while in G II; SLN was positive in 31 out of 36 (86.1%) cases and negative in 5 (13.9%) cases with no significant difference regarding SLN accuracy or FNR. Conclusion: The tumor location doesn’t affect axillary SLNB regarding identification rate, accuracy rate and false negativity rate. Methylene blue alone is still efficacious in SLNB lymphatic mapping especially in developing countries because of its low cost.

Breast cancer SLNB identification rate Accuracy rate false negativity rate Methylene blue lymphatic mapping

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[1]  Samphao S, Eremin JM, El-Sheemy M, Eremin O. Management of the axilla in women with breast cancer: current clinical practice and a new selective targeted approach. Ann Surg Oncol 2008 May; 15(5): 1282-96.
[2]  Wang Z, Wu L-C, Chen J-Q. Sentinel lymph node biopsy compared with axillary lymph node dissection in early breast cancer: a meta-analysis. Breast Cancer Res Treat. 2011; 129(3): 675-89.
[3]  Shaji Thomas, Apurva Prakash, Vinay Goyal, Manju Bala Popli, Shilpi Agarwal, and Monisha Choudhury: Evaluation of Sentinel Node Biopsy in Locally Advanced Breast Cancer Patients Who Become Clinically Node-Negative after Neoadjuvant Chemotherapy: A Preliminary Study. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861. Volume 15, Issue 6 Ver. V (June. 2016), PP 30-36
[4]  Giuliano AE, Hunt KK, Ballman KV, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011; 305(6):569-75.
[5]  Galimberti V, Cole BF, Zurrida S, et al. Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): a phase 3 randomised controlled trial. Lancet Oncol. 2013; 14(4): 297-305.
[6]  Macéa, J. R. & Fregnani, J. H. T. G. Anatomy of the thoracic wall, axilla and breast. Int. J. Morphol., 24(4):691-704, 2006.
[7]  Ahmed M, Purushotham AD, Horgan K, et al. Meta-analysis of superficial versus deep injection of radioactive tracer and blue dye for lymphatic mapping and detection of sentinel lymph nodes in breast cancer. Br J Surg. 2015; 102(3): 169-81.
[8]  Donker M, van Tienhoven G, Straver ME, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol. 2014; 15(12):1303-10.
[9]  A.Tassenoy, p. van der veen, a. bossuyt, j. lamote, p. lievens: lymphatic pathways of the upper medial quadrant of the breast in healthy women: radiotracer study of the sentinel lymph node. Lymphology 35 (2002) 153-60.
[10]  Niels Kroman, Jan Wohlfahrt, Henning T. Mouridsen and Mads Melbye: Influence of tumor location on breast cancer prognosis. Int. J. Cancer 2003:105, 542-5.
[11]  Kim, T.; Giuliano, A. E. & Lyman, G. H. Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a meta-analysis. Cancer, 106:4-16, 2006.
[12]  Byrd, DR, LK Dunnwald, DA Mankoff, et al: Internal mammary lymph node drainage patterns in patients with breast cancer documented by breast Iymphoscintigraphy. Ann. Surg. Oncol. 8 (2001), 234-40.
[13]  Uren, R, RB Howman-Giles, SB Renwick: Lymphatic mapping of the breast: Locating the sentinel lymph nodes. World J. Surg. 25 (2001), 789-93.
[14]  Dupont, EL, VJ Kamath, EM Ramnath, et al: The role of Iymphoscintigraphy in the management of the patient. with breast cancer. Ann. Surg. Oncol. 8 (2001), 354-360.
[15]  Vendrell-Torne E, Setoain-Quinquer J, Domenech-Torne FM. Study ´ of normal mammary lymphatic drainage using radioactive isotopes. J Nucl Med 1972; 13:801-5.
[16]  M. A. Warmuth, G. Bowen, L. R. Prosnitz et al.: Complications of Axillary lymph node dissection for carcinoma of the breast: a report based on a patient survey. Cancer, vol. 83, no.7, pp. 1362-8, 1998.
[17]  Krag DN, Anderson SJ, Julian TB, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol. 2010; 11(10): 927-33.
[18]  Paganelli, G, C De Cicco, M Cremonesi, et al: Optimized sentinel node scintigraphy in breast cancer. Quart. J. Nucl. Med. 42 (1998), 49-53.
[19]  Krag, D. N. et al. Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial. Lancet Oncol. 881-8 (2007).
[20]  Canavese G, Bruzzi P, Catturich A, Tomei D, Carli F, Garrone E, et al. Sentinel lymph node biopsy versus axillary dissection in node-negative early-stage breast cancer: 15-year follow-up update of a randomized clinical trial. Ann Surg Oncol 2016 Aug; 23(8): 2494-500.