Sentinel node dissection10/11/2023 However, the sensitivity of FS is limited, with a false-negative rate of up to approximately 20%, which may lead to patients being recalled for ALND ( 6– 14). Frozen section (FS) is the most widely used method in the intraoperative assessment of SLNs, which has the advantage to proceed immediately to ALND in patients with positive SLNs, avoiding a second axillary surgery ( 4, 5). Over the last two decades, sentinel lymph node biopsy (SLNB) is considered the standard of care for axillary staging in early breast cancer patients with cN0, with axillary lymph node dissection (ALND) only reserved for patients with positive SLNs ( 2, 3). The status of ALN can affect postoperative treatment options, including adjuvant chemotherapy and adjuvant radiotherapy (RT) ( 1). SLNB is relatively sufficient in the IBCSG 23-01-eligible patients, and axillary radiation was an effective option in the AMAROS-eligible patients.Īxillary lymph node (ALN) metastasis is one of the significant prognostic factors in early breast cancer. The positive rate of non-SLNs was 18.27% (19/104).Ĭonclusion: ALND can be carefully omitted in selected breast cancer patients with mastectomy and false-negative FS in SLNB. Also, in 174 patients who met the criteria of the AMAROS trial, RFS and OS in the non-ALND and ALND groups were similar ( p = 0.930 and 0.616). The positive rate of non-SLNs was 9.62% (5/52). In subgroup analysis, we found that 97 patients who met the inclusive criteria of the IBCSG 23-01 trial had similar RFS and OS between the non-ALND and ALND groups ( p = 0.856 and 0.298). After a median follow-up of 59.43 months, RFS and OS of the two groups were similar ( p = 0.994 and 0.441). Also, removing more SLNs (≥3) was related to negativity in non-SLNs (OR, 0.255 p = 0.016). The positivity of non-SLNs in the ALND group was associated with SLN macrometastasis (OR, 3.551 p = 0.043) and lymphovascular invasion (OR, 6.158 p = 0.003). In multivariate analysis, we found that patients with larger tumor size (>2 cm) (OR, 1.989 p = 0.030) and multifocal lesions (OR, 3.542 p = 0.029) tended to receive ALND. The positive rate of non-sentinel lymph nodes (SLNs) was 15.87% (20/126) in the ALND group. Results: A total of 212 patients were included, 86 and 126 patients in the non-ALND and ALND groups, respectively. Patients with false-negative FS in SLNB were separated by the following management of axillary lymph node dissection in the non-ALND group (nonprocess or axillary radiation only) and ALND group (with or without radiation). ![]() Materials and Methods: This was a retrospective study of cN0 patients diagnosed with primary invasive breast cancer treated by mastectomy and SLNB at our institute between January 2010 and December 2014. The aim of this study was to determine whether breast cancer patients with mastectomy and false-negative frozen section (FS) in SLNB could forgo ALND. ![]()
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