Research Article| Volume 36, ISSUE 8, P737-744, August 2010

Download started.


Intra-operative evaluation of the sentinel lymph node for T1-N0 breast-cancer patients: Always or never? A risk/benefit and cost/benefit analysis



      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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to European Journal of Surgical Oncology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kim T.
        • Giuliano A.E.
        • Lyman G.H.
        Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a metaanalysis.
        Cancer. 2006; 106: 4-16
        • Krag D.N.
        • Anderson S.J.
        • Julian T.B.
        • et al.
        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
        • Mansel R.E.
        • Fallowfield L.
        • Kissin M.
        • et al.
        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
        • Veronesi U.
        • Paganelli G.
        • Galimberti V.
        • et al.
        Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes.
        Lancet. 1997; 349: 1864-1867
        • Giuliano A.E.
        • Jones R.C.
        • Brennan M.
        • Statman R.
        Sentinel lymphadenectomy in breast cancer.
        J Clin Oncol. 1997; 15: 2345-2350
        • Krag D.
        • Weaver D.
        • Ashikaga T.
        • et al.
        The sentinel node in breast cancer-a multicenter validation study.
        N Engl J Med. 1998; 339: 941-946
        • Schwartz G.F.
        • Giuliano A.E.
        • Veronesi U.
        • Consensus Conference Committee
        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
        • Lyman G.H.
        • Giuliano A.E.
        • Somerfield M.R.
        • et al.
        • American Society of clinical Oncology
        American society of clinical oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer.
        J Clin Oncol. 2005; 23: 7703-7720
        • Silverstein M.J.
        • Lagios M.D.
        • Recht A.
        • et al.
        Image-detected breast cancer: state of the art diagnosis and treatment.
        J Am Coll Surg. 2005; 201: 586-597
        • Weiser M.R.
        • Montgomery L.L.
        • Susnik B.
        • Tan L.K.
        • Borgen P.I.
        • Cody H.S.
        Is routine intraoperative frozen-section examination of sentinel lymph nodes in breast cancer worthwhile?.
        Ann Surg Oncol. 2000; 7: 651-655
        • Chan S.W.
        • LaVigne K.A.
        • Port E.R.
        • et al.
        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
        • Canavese G.
        • Catturich A.
        • Vecchio C.
        • et al.
        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