Medknow Publications on behalf of Indian Cancer Society
Abstract
BACKGROUND : In many patients with early breast cancer, the sentinel
lymph node (SLN) is the sole site of regional nodal metastasis. This
subgroup of patients may not benefit from completion axillary lymph
node dissection (CALND). AIMS: This pilot study evaluates the status
of 2nd echelon (station) lymph nodes in the axilla as a predictor of
additional positive nodes in the axilla in the presence of sentinel
node metastasis. SETTINGS AND DESIGN: Cross-sectional study of 40
breast cancer patients. MATERIALS AND METHODS: Forty patients with
invasive breast cancer underwent SLN biopsy followed by 2nd echelon
lymph node biopsy in the same sitting. SLN mapping was performed using
a combined technique of isosulfan blue and 99 mTc-sulfur colloid. SLNs
(Station I) were defined as blue and/or hot nodes. These nodes were
then injected with 0.1 ml of blue dye using a fine needle and their
efferent lymphatic was traced to identify the Station II nodes. Then a
complete ALND was performed. All the specimens were sent separately for
histopathological evaluation. RESULTS : SLNs (Station I nodes) were
successfully identified in 98% (39/40) patients. Of the 17 patients
with a positive SLN, 8 (47%) patients had no further positive nodes in
the axilla, 9 (53%) patients had additional metastasis in nonsentinel
lymph nodes upon CALND. Station II nodes were identified in 76% (13/17)
patients with a positive SLN. Station II nodes accurately predicted the
status of the remaining axilla in 92% patients (12/13). STATISTICAL
ANALYSIS : We calculated the Sensitivity, Negative predictive value,
Positive predictive value, False negative rate and Identification rate.
CONCLUSION : Station II nodes may predict metastatic involvement of
additional nodes in the axilla