Sentinel lymph node biopsy in breast cancer New indications and our experience

Abstract

INTRODUCTION: Owing to complexity and difficulty regarding evaluation of all the regional lymph nodes, the Sentinel Lymph Node Biopsy (SLNB) has represented in recent years a suitable technique for setting lymph node status; it allows pathologists to focus on a small number of lymph nodes and stage patients with clinically negative lymph nodes; this sort of assessment leads surgeons to a correct approach; on the contrary, the presence of metastases makes advisable to perform Axillary Lymph Node Dissection (ALND).

MATERIALS AND METHODS: From September 2008 to December 2013, 142 patients suffering from breast cancer were enrolled. Mean age was 54 years (range 37-80), in 88 (62%) patients the lesion was localized to the right breast, while in the remaining 54 (38%) the disease was localized in the left breast. Also in 85 (60%) patients, the tumor involved the upper-outer quadrant, in 24 (17%) the lower external quadrant, in 19 (13%) the upper-inner quadrant and in the remaining 14 (10%) the inferior-internal quadrant.

RESULTS: There were neither intra nor post-operative complications. The all removed breast lesions were histologically malignant: 99 (70%) patients had a histological diagnosis of invasive ductal, 30 (21%) of invasive lobular, 9 (6%) ductal in situ and 4 (3%) of mixed invasive cancer. Sentinel Lymph Node (SLN) was always identified and it was extemporaneously positive in 62 cases (44%): 40 cases had macro-metastatic involvement whereas the remaining 22 cases had micro-metastases only. The definitive histological examination confirmed the presence of micro-metastases in 18 cases, while in 2 cases there was a supra-staging to macro-metastases and in other 2 a sub-staging of Isolated Tumor Cells (ITC). None of the patients with micro-metastatic SLN involvement developed recurrence within 24 months, whereas only one patient died after one year owing to at distance dissemination.

CONCLUSION: Lymph node status has increasingly been getting one of the most important prognostic factor. Consequently the bigger the tumor nodal involvement appears the worse the prognosis becomes. Our data confirm the main role of SLNB on managing surgical treatment of breast cancer.