Sentinel nodes how many

Arch Surg. Patients A total of patients underwent SLN biopsy followed by completion axillary node dissection. Results Of the patients in this study, an SLN was identified in Of the patients in whom a SLN was identified, The overall FNR in this study was 7.

In Sentinel lymph node SLN biopsy is a well-accepted, minimally invasive technique that has been shown to accurately stage the axilla in patients with breast cancer. On average, 2 to 3 SLNs are removed. However, on occasion, multiple SLNs can be identified. The University of Louisville Breast Sentinel Lymph Node Study is a multi-institutional prospective study in which patients with clinical stage I or II breast cancer underwent SLN biopsy followed by completion axillary lymph node dissection.

Three hundred thirty-six surgeons from Canada and the United States participated in this study. The study was approved by the institutional review board at each site, and the patients signed informed consent forms before their participation.

The technique of SLN biopsy used was left to the discretion of each surgeon. Sentinel node biopsy was not limited to a certain number of nodes in this study. All statistical analyses were performed using SPSS statistical software, version From May 7, , to August 2, , patients were enrolled in this study.

The median patient age was 60 years range, years , and the median tumor size was 1. A sentinel node was identified in patients A median of 2 SLNs were removed range, , with more than 3 nodes removed in patients These node-positive patients formed the cohort of interest for this study.

The clinicopathologic features of this cohort are given in Table 1. The distribution of node-positive cases according to the number of SLNs removed is given in Table 2. A median of 13 nodes were removed after completion axillary dissection range, , with a median of 2 positive nodes on final pathologic analysis range, The frequency of having the first sign of metastasis in the n th sentinel node and the cumulative true-positive rate for a given number of SLNs removed are given in Table 3.

In these patients, more than 1 positive node was found in 49 patients In addition, the SLN metastasis was found using hematoxylin-eosin staining in 50 Sentinel node biopsy has become a cornerstone of breast cancer management and has been shown to accurately stage the axilla in patients with breast cancer.

The significance of these latter SLNs has been questioned in recent studies. In their study of patients who underwent an SLN biopsy for breast cancer, the median number of SLNs removed was 2. Of the node-positive patients in their study, metastatic disease was identified within the first 3 SLNs removed. In addition, Low and Littlejohn, 4 in a study of patients with a mean of 1. In our larger study of patients, we found that Therefore, 2. Am J Surg 3 — Medicine 95 14 :e Br J Surg.

Article Google Scholar. Br J Surg 1 — Download references. You can also search for this author in PubMed Google Scholar. Correspondence to J. Michael Dixon. This article does not contain any studies with human participants or animals performed by any of the authors. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material.

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Reprints and Permissions. Dixon, J. Factors affecting the number of sentinel lymph nodes removed in patients having surgery for breast cancer. Breast Cancer Res Treat , — Download citation. Received : 08 May Accepted : 28 July Published : 18 August Issue Date : November Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search SpringerLink Search. Download PDF. Abstract Purpose The goal of sentinel lymph node biopsy is to establish the presence or absence of cancer cells in regional axillary nodes. Methods Data from patients with breast cancer who underwent sentinel lymph node biopsy at the Edinburgh Breast Unit by 10 different experienced breast surgeons were included in this analysis.

Conclusions This study shows that the surgeon plays a pivotal and significant role in determining the numbers of sentinel nodes removed by sentinel lymph node biopsy. Introduction The lymphatic system was discovered in by Bartholin. Methods Database and study population Data were collected retrospectively from the Edinburgh Breast Unit at the Western General Hospital, Edinburgh with the aim of acquiring 50 patients for each of the 10 experienced breast surgeons.

Statistical analysis Distribution of data was determined to be non-normal using the Kolmogorov—Smirnov test and testing for equivalent mean and variance. Results Patient characteristics Table 1 displays patient cohort data for a cohort of patients who met the inclusion criteria in relation to each variable for which data were collected.

Table 1 Baseline characteristics of patient cohort displayed in relation to each variable Full size table. Full size image. Discussion This study has shown that a variety of factors have an impact on the number of sentinel nodes identified using isotope and blue dye that were removed during sentinel node biopsy.

References 1. Funding No funding is associated with this article. Michael Dixon View author publications. View author publications. Ethics declarations Conflict of interest The authors confirm they have no conflicts of interest to declare. Informed consent Not applicable. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Pathologically positive axillary lymph nodes were identified in Clinicopathological characteristics of the patients with positive axillary lymph nodes were compared with 12 cases of false negative patients and 99 cases of true positive using the chi-square test. No differences in age distribution, tumor size, estrogen receptor status, or histological grade were observed data not shown.

Therefore, 12 3. The number of SLNs removed and the corresponding number of patients are summarized in Table 2. Ninety-two patients More than four SLNs were removed in 65 patients The accuracy of SLNB was The overall pathological status of SLN and axillary lymph nodes are summarized in Table 4. False negative rate is A SLN is defined as the first node to receive lymphatic drainage from a primary tumor bed [ 4 , 5 ]; however, the actual experience of most investigators includes more than one SLN and controversy still exists regarding the optimal number of radioactive SLNs that should be removed to ensure accuracy and minimize morbidity [ 6 , 7 ].

One of the possible explanations for identifying multiple SLNs is the "pass-through" phenomenon, which reflects isotope migration from the "true" SLN into secondary echelon lymph nodes. Another simple explanation is normal anatomical variation in which the lymphatics of a given site simultaneously drain into more than one SLN [ 7 ]. So, an acceptable accuracy of axillary staging must be determined to minimize SLNB-related morbidity. How many sentinel nodes should be removed to achieve appropriate accuracy of axillary staging without negating the potential benefits of SLNB?

We hypothesized that there is a point when the surgeon can terminate the procedure without sacrificing SLNB accuracy. Our data are quite comparable to the majority of published series that have evaluated the optimal number of SLNs and support the trend of limiting SLN biopsy to lymph nodes. Although no clear data exist regarding limiting axillary dissection based on relative radioactive counts, limiting SLNB to a reasonable number of nodes, about 3 or 4, is well supported by several case series, including this report.

These data demonstrate that the total number of SLNs to be excised can be limited to four without jeopardizing the accuracy of axillary staging. In , McCarter et al.

However, indiscriminate removal of axillary nodes may not be justified, considering operative complications and resource utilization associated with SLNB. Furthermore, cost-effectiveness and cost utilization studies have found that excising a high number of SLNs is associated with longer operation time, higher pathology costs, and higher procedural costs [ 22 ]. Terminating the procedure after the fourth node may lower the cost of the procedure and reduce morbidity.

In our series, FNR was It has been established that the SLN with the highest radioactive counts is not always the SLN that is most likely to harbor metastatic disease [ 26 , 27 ]. Why is an SLN not necessarily the "hottest" node in the lymphatic basin? We can offer three reasons for this. First, when the radioactive tracer passes through an SLN, if the next lymph node stage is relatively large or if there are active phagocytic cells, more radioactivity material is accumulated than in the first lymph node stage.

Second, the amount of radioactive tracer accumulated in a lymph node not only depends on the order of drainage but also reflects the number of lymphatic channels and lymphatic flow. Last, if a true SLN is occupied by metastatic cells, it cannot absorb radioactive tracer. In that case, another lymph node will ingest tracer and be recognized as an SLN. Therefore, we cannot say that the so-called "hottest node," which absorbs the most radioactive tracer, is always the first SLN [ 28 , 29 ]. In this respect, to find the SLNs in a case of fewer than four hot nodes should be a very important line of research in the near future.

Limitation of the present study was a different proportion of operation methods compared to the nationwide Korean Breast Cancer Society KBCS registration program.

Since type of surgery is determined not only by tumor size but also by various clinicopathological parameters, radiological findings, or a patient's desire, our present results using selected study cohort at single institution remain to validated in an independent dataset.

Biopsy of an insufficient number of lymph nodes LNs may produce a false negative result, while excision of too many contradicts the SNB idea itself, turning it into an incomplete lymphadenectomy.

We aim at establishing the minimal number of LNs that must be removed without compromising the reliability. During years to , 1, SNBs were performed in our department. Invasive cancer was diagnosed in 1, cases and these were included in our present study. All LNs were marked in order of their expressed radioactivity and subsequent removal.

The number of excised sentinel nodes varied from one to nine, the average was 2. Table 1 presents groups of patients with particular numbers of sentinel LNs excised and percentages of metastases found. Biopsy of more than five LNs proved to be of no additional value.