Optimal Sampling Number of Sentinel Lymph Nodes in Invasive Breast Cancer: Results of 1,026 Sentinel Lymph Node Biopsies Done by Radioisotope

Jung Eun Choi; Shin Young Park; Myung Hoon Jeon; Su Hwan Kang; Young Kyung Bae; Soo Jung Lee

doi:10.4048/jbc.2011.14.S.S37

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Choi, Park, Jeon, Kang, Bae, and Lee: Optimal Sampling Number of Sentinel Lymph Nodes in Invasive Breast Cancer: Results of 1,026 Sentinel Lymph Node Biopsies Done by Radioisotope

Original Article

Journal of Breast Cancer

Journal of Breast Cancer 2011; 14(Suppl 1): S37-S43.

Published online: 28 February 2011

DOI: https://doi.org/10.4048/jbc.2011.14.S.S37

Optimal Sampling Number of Sentinel Lymph Nodes in Invasive Breast Cancer: Results of 1,026 Sentinel Lymph Node Biopsies Done by Radioisotope

Jung Eun Choi, Shin Young Park, Myung Hoon Jeon, Su Hwan Kang, Young Kyung Bae¹, Soo Jung Lee

Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea.

¹Department of Pathology, Yeungnam University College of Medicine, Daegu, Korea.

Correspondence: crystallee@med.yu.ac.kr

Received 9 July 2010 Accepted 28 January 2011

Abstract

Purpose

For isotope mapping, many authors have defined the sentinel lymph node (SLN) as the one containing isotope counts higher than the axillary background. However, no study has sought to define an optimal guideline, and the number of SLNs needed for precise detection of metastatic SLNs is still a subject of debate. Accordingly, we set out to determine the optimal sampling number of SLNs.

Methods

Between January 2005 and December 2008, we enrolled 1,026 patients with primary invasive breast cancer. These patients had received sentinel lymph node biopsy (SLNB) using radioisotopes at Yeungnam University Hospital. During SLNB, ex vivo isotope counts were measured for each SLN. And, the number and metastatic status of harvested SLNs were investigated. We defined SLNs as lymph nodes that show an isotope count ≥ 10 times that of the axillary background. Each SLN was labeled as S1 (highest isotope count), S2 (second highest), or S3 and so on, in descending isotope-count-order. If an SLN was positive for metastasis, completion axillary lymph node dissection was performed.

Results

The mean age of patients was 48.9 years (ranges, 22-83 years). The mean number of removed SLNs was 2.8 (ranges, 1-11). Of the 1,026 patients enrolled, 311 (30.3%) had SLN metastasis: S1 was positive (S1+) in 258 patients (82.9%), S2 was positive (S1-, S2+) in 40 patients (12.3%), and S3 was positive (S1-, S2-, S3+) in 13 patients (3.9%). There was no metastasis in SLNs defined as S4, S5 and so on. The average number of sampling SLNs until detecting metastasis in S1, S2, and S3 was 1.24 (1-4), 2.45 (2-4), and 3.46 (3-5).

Conclusion

During SLNB done using radioisotopes, for accurate axillary lymph node staging, up to the 3rd isotope-count-order of SLNs should be removed. The average number of SLNs needed for detecting metastasis in S3 is four.

Keywords: Breast neoplasms, Radioisotopes, Sentinel lymph node biopsy

Figures and Tables

Figure 1

Metastatic status of axillary lymph nodes.

SLNB=sentinel lymph node biopsy; ALND=axillary lymph node dissection.

Table 1

Baseline characteristics of the patients

BCS=breast conserving surgery; IDC=invasive ductal carcinoma; ILC=invasive lobular carcinoma; SLN=sentinel lymph node.

Table 2

Clinicopathologic factors influencing to metastasis in the sentinel lymph node

SLN=sentinel lymph node; LVI=lymphovascular invasion; ER=estrogen receptor; IDC=invasive ductal carcinoma; ILC=invasive lobular carcinoma.

Table 3

Metastatic status of SLN and the corresponding percentage of patients on the basis of the order of radioisotope count

SLN=sentinel lymph node.

Table 4

The needed number of harvested SLN until identifying metastasis

SLN=sentinel lymph node.

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