Optimized Criteria for Sentinel Lymph Node Biopsy in Patients with Clinically Node Negative Breast Cancer

다국어 초록 (Multilingual Abstract)

Purpose: Sentinel lymph node biopsy (SLNB) is a well-established staging procedure for patients with early breast cancer who have clinically negative axillary lymph node. However, no consensus exists about the number of sentinel lymph nodes (SLN) that should be removed based on radioactivity counts in breast cancer. We reviewed and analyzed cases in which more than one SLN was detected and there was at least one pathologically positive node. Methods: We retrospectively studied breast cancer patients who underwent lymphoscintigraphy with injection of a radioactive colloid and SLNB along with intraoperative determination of radioactive counts of lymph nodes using a gamma probe between 2006 and 2018. In total 326 patients with more than one radioactive SLN were enrolled in this study. Results: Fifty-four patients had nodal metastases, of whom 46 (85.2%) had metastases in the hottest lymph node. All metastatic SLNs were identified as one of the first three lymph nodes dissected. The lowest radioactive count of a positive SLN corresponded to 10% of that of the hottest node. Conclusion: We suggest that removal of the first three lymph nodes or nodes covered by the “10% rule” is sufficient in SLNB for patients with breast cancer.

참고문헌 (Reference)

1 Collins CD, "The sentinel node in breast cancer : an update" 5 : S3-9, 2005

2 Dabbs DJ, "The optimal number of sentinel lymph nodes for focused pathologic examination" 10 : 186-189, 2004

3 McCarter MD, "The breast cancer patient with multiple sentinel nodes: when to stop?" 192 : 692-697, 2001

4 Göker M, "Systematic review of breast cancer related lymphoedema : making a balanced decision to perform an axillary clearance" 5 : 106-115, 2013

5 Woznick A, "Sentinel lymph node dissection for breast cancer: how many nodes are enough and which technique is optimal?" 191 : 330-333, 2006

6 McMasters KM, "Sentinel lymph node biopsy for breast cancer : a suitable alternative to routine axillary dissection in multi-institu-tional practice when optimal technique is used" 18 : 2560-2566, 2000

7 Dutta R, "Re-visiting the"10% rule"in breast cancer sentinel lymph node biopsy : an approach to minimize the number of sentinel lymph nodes re-moved" 203 : 623-627, 2012

8 Nakagawa M, "Preoperative diagnosis of sentinel lymph node(SLN)metastasis us-ing 3D CT lymphography(CTLG)" 23 : 519-524, 2016

9 Joyce DP, "Management of the axilla: has Z0011 had an impact?" 185 : 145-149, 2016

10 Yi M, "How many sentinel lymph nodes are enough during sentinel lymph node dissection for breast cancer?" 113 : 30-37, 2008

11 Eun Jeong Ban, "How Many Sentinel Lymph Nodes Are Enough for Accurate Axillary Staging in T1-2 Breast Cancer?" 한국유방암학회 14 (14): 296-300, 2011

12 Giuliano AE, "Effect of axillary dissection vs no axillary dissec-tion on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis : the ACOSOG Z0011(alliance)randomized clinical trial" 318 : 918-926, 2017

13 Subhedar P, "Do the ACOSOG Z0011 criteria affect the number of sentinel lymph nodes removed?" 22 : 470-475, 2015

14 Nakauchi C, "Development of a prediction model for lymph node metastasis in luminal A subtype breast cancer : the possibility to omit sentinel lymph node biopsy" 353 : 52-58, 2014

15 Colakoglu MK, "Bio-logical subtypes of breast cancer and sentinel lymph node biopsy" 14 : 100-104, 2018