Prediction of Non Sentinel Nodal Metastases After Positive Sentinel Lymph Node Biopsy for Early Breast Cancer – Burney Breast Unit Experience

Published Date: 19th July 2016

Publication Authors: Galea M, Jois RHS, Swaminathan V, Chagla LS, Thind R, Harris O, Desmond S,

Background: Sentinel lymph node biopsy (SLNB) is an established method of assessing axillary node status in women with early breast cancer. The primary aim of SLNB is to understand lymph node status with minimal morbidity. Current practice is to offer completion axillary clearance for those women with metastases in sentinel lymph node (SLN). However the majority of patients, SLN is the only nodal involvement and so axillary dissection serves no therapeutic purpose. The aim of this study was to identify the biological predictors associated with non SLN metastases after positive SLNB.

Materials and Methods: A consecutive series of patients underwent SLNB and further axillary dissection for sentinel nodal metastases between 2008 and 2010. The outcomes of SLN and nodal disease were observed. Logistical regression analysis was performed on the data set to identify the tumour related factors associated with non sentinel nodal metastases.

Results: SLNB was performed on 350 patients (median age, 59 years). The median number of SLNB was 1. Of these, 297 (85%) had invasive ductal carcinoma and 174 (78%) were grade 2 cancer. The median tumour size was 14 mm. Lymphovascular invasion (LVI) was present in 58 patients (17%). 57 patients underwent axillary node dissection (median number of axillary nodes retrieved, 11.5). Of these, 20 (35%) patients had further axillary nodal disease. Multivariate regression analysis showed that lymphovascular invasion (p < 0.000), primary tumour size (p < 0.045) and tumour grade (p < 0.039) were associated with non SLN disease after a positive SLNB.

Conclusions: The results of this study demonstrate that LVI, tumour size and tumour grade are associated with non sentinel node metastases. These biological markers could be implemented as a tool in the selection of patents that would benefit from complete axillary clearance.

Galea, M; Jois, RHS; Swaminathan, V; Chagla, LS; Thind, R; Harris, O; Desmond, S; Audisio, RA. (2012). Prediction of non sentinel nodal metastases after positive sentinel lymph node biopsy for early breast cancer-burney breast unit experience. European Journal of Cancer. 48 (Supp 1), S142

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