To investigate whether omitting intra-operative staging of the sentinel lymph node (SLN) in T1-N0 breast-cancer patients is feasible and convenient because it could allow a more efficient management of human and logistic resources without leading to an unacceptable increase in the rate of delayed axillary lymph node dissection (ALND).
According to the experimental procedure, T1a–T1b-patients were to not receive any intra-operative SLN evaluation on frozen sections (FS). In all T1c-patients, the SLN was macroscopically examined; if the node appeared clearly free of disease, no further intra-operative assessment was performed; if the node was clearly metastatic or presented a dubious aspect, the pathologist proceeded with analysis on FS. T2-patients, enrolled in the study as reference group, were treated according to the institutional standard procedure; they all received SLN staging on FS.
The study included 395 T1-N0-patients. Among the 118 T1a–T1b-patients whose SLN was not analyzed at surgery, 12 (10.2%) were recalled for ALND. In the group of 258 T1c-patients, 112 received SLN analysis on FS and 146 did not. An SLN falsely negative either at macroscopic or FS examination was found in 33 (12.8%) cases. Overall, the rate of recall for ALND was 11.6% as compared to 8.4% in T2-patients. Using the experimental protocol, the institution reached a 9.6% cost saving, as compared to the standard procedure.
Omission of SLN intra-operative staging in T1-N0-patients is rather safe. It provides the institution with both management and economical advantages.
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- Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a metaanalysis.Cancer. 2006; 106: 4-16
- National surgical adjuvant breast and bowel project. 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. 2007; 8: 881-888
- Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC trial.J Natl Cancer Inst. 2006; 98: 599-609
- Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes.Lancet. 1997; 349: 1864-1867
- Sentinel lymphadenectomy in breast cancer.J Clin Oncol. 1997; 15: 2345-2350
- The sentinel node in breast cancer-a multicenter validation study.N Engl J Med. 1998; 339: 941-946
- Proceedings of the consensus conference on the role of sentinel lymph node biopsy in carcinoma of the breast, April 19–22, 2001, Philadelphia, Pennsylvania.Cancer. 2002; 94: 2542-2551
- American society of clinical oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer.J Clin Oncol. 2005; 23: 7703-7720
- Image-detected breast cancer: state of the art diagnosis and treatment.J Am Coll Surg. 2005; 201: 586-597
- Is routine intraoperative frozen-section examination of sentinel lymph nodes in breast cancer worthwhile?.Ann Surg Oncol. 2000; 7: 651-655
- Does the benefit of sentinel node frozen section vary between patients with invasive duct, invasive lobular, and favorable histologic subtypes of breast cancer?.Ann Surg. 2008; 247: 143-149
- Sentinel node biopsy compared with complete axillary dissection for staging early breast cancer with clinically negative lymph nodes: results of randomized trial.Ann Oncol. 2009; 20: 1001-1007
Accepted: June 7, 2010
© 2010 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.