Scientific paperCompletion axillary lymph node dissection minimizes the likelihood of false negatives for patients with invasive breast carcinoma and cytokeratin positive only sentinel lymph nodes
Section snippets
Methods
All patients from April 1998 through May 2001 at the H. Lee Moffitt Cancer Center who underwent lymphatic mappings and SLN biopsies for invasive breast cancer, were reviewed regarding lymph node status. This time period was chosen for analysis to assure all surgeons were beyond their “learning curves” for accurate mapping. All data were collected prospectively, including examination of lymph nodes reported by staff pathologists, and stored in a computerized database.
Lymphatic mapping and SLN
Results
From April 1998 through May 2001, 1,380 patients with invasive breast carcinoma underwent lymphatic mapping and SLN biopsy at MCC. In all, 409 patients (29.6%) had metastatic disease in at least one sentinel lymph node on evaluation of H&E stained sections; and 78 (5.6%) had cytokeratin positive only cells on immunostaining for cytokeratin, ie, no malignant cells could be documented on H&E stains of the sentinel lymph node. Sixty-two of the CK-IHC-positive-only patients underwent CALND in a
Comments
Sentinel lymph node biopsy offers the advantage of decreasing the morbidity associated with staging by routine CALND while simultaneously increasing the accuracy of the lymph nodes examined. This has resulted in SLN biopsy rapidly becoming accepted in the management of breast cancer. The accuracy of this technique has been validated 3. Two key factors are generally used to characterize the success of lymphatic mapping: the SLN identification rate and the false negative rate. Factors previously
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Meta-analysis of predictive factors for non-sentinel lymph node metastases in breast cancer patients with a positive SLN
2011, European Journal of Surgical OncologyCitation Excerpt :Furthermore, 4 studies were excluded for not presenting raw data on the association between patient/tumour characteristics and positive non-sentinel nodes.16,24,82,83 Two studies only included patients with positive sentinel lymph nodes identified with cytokeratin-immunohistochemistry.84,85 In 1 study, predictive factors in special tumour types were evaluated.86
The significance of immunohistochemistry positivity in sentinel nodes which are negative on haematoxylin and eosin in breast cancer
2009, European Journal of Surgical OncologyCitation Excerpt :The current study reveals occult metastases in 5% of cases. This in turn leads to a reduction in the false negative rate of the technique.10 This upstaging of disease may confer a worse prognosis.
Significance of Sentinel Lymph Node Micrometastases in Human Breast Cancer
2008, Journal of the American College of SurgeonsCitation Excerpt :For these patients, the chance of finding additional positive nodes generally increased with tumor size. Although this was a retrospective study, and reasons for performing an axillary dissection were not always available, our results for finding additional axillary disease are similar to previous published data.6,8-15 The detection of micrometastatic carcinoma (N1mi) in the SLNs of patients with invasive breast cancer is a major predictor of overall survival.
Regional Node Dissection for Melanoma: Techniques and Indication
2007, Surgical Oncology Clinics of North AmericaCitation Excerpt :Even in patients with minimal disease confined to the SLN as defined by IHC positive only, 13.7% had a positive non-SLN [25]. This incidence is almost identical to prior studies in breast cancer with IHC only detected sentinel lymph node disease followed by complete axillary node dissection [26]. In breast cancer, nomograms have been produced to help guide the patient and physician on the likelihood of finding further nodal disease at the time of complete node dissection [27].
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