Non-Sentinel Lymph Node Metastases Associated With Isolated Breast Cancer Cells in the Sentinel Node
Authors:
- C. H. M. van DeurzenCDC. H. M. van Deurzen
- M. de BoerMBM. de Boer
- E. M. MonninkhofEME. M. Monninkhof
- P. BultPBP. Bult
- E. van der WallEWE. van der Wall
- V. C. G. Tjan-HeijnenVTV. C. G. Tjan-Heijnen
- P. J. van DiestPDP. J. van Diest
- 11 November 2008
- journal article
- research article
- Published by Oxford University Press (OUP) in JNCI: Journal of the National Cancer Institute
- Vol. 100 (22) , 1574-1580
Abstract
There are many reports on the frequency of non-sentinel lymph node involvement when isolated tumor cells are found in the sentinel node, but results and recommendations for the use of an axillary lymph node dissection differ among studies. This systematic review was conducted to give an overview of this issue and to provide recommendations for the use of an axillary lymph node dissection in these patients. We searched Medline, Embase, and Cochrane databases from January 1, 2002, through November 27, 2007, for articles on patients with invasive breast cancer who had isolated tumor cells in the sentinel lymph node (according to the sixth edition of the Cancer Staging Manual of the American Joint Committee on Cancer) and who also underwent axillary lymph node dissection. Of 411 selected articles, 29 (including 836 patients) were included in this review. These 29 studies were heterogeneous, reporting a wide range of non-sentinel lymph node involvement (defined as the presence of isolated tumor cells or micro- or macrometastases) associated with isolated tumor cells in the sentinel lymph node, with an overall pooled risk for such involvement of 12.3% (95% confidence interval = 9.5% to 15.7%). This pooled risk estimate was marginally higher than the risk of a false-negative sentinel lymph node biopsy examination (ie, 7%-8%) but marginally lower than the risk of non-sentinel lymph node metastases in patients with micrometastases (ie, approximately 20%) who are currently eligible for an axillary lymph node dissection. Because 36 (64%) of the 56 patients with isolated tumor cells in their sentinel lymph node also had non-sentinel lymph node macrometastases, those patients with isolated tumor cells in the sentinel lymph node without other indications for adjuvant systemic therapy might be candidates for axillary lymph node dissection.Keywords
This publication has 54 references indexed in Scilit:
- Micrometastases in Sentinel Lymph Node in a Multicentric Study: Predictive Factors of Nonsentinel Lymph Node Involvement—Groupe Des Chirurgiens De La Federation Des Centres De Lutte Contre Le CancerJournal of Clinical Oncology, 2006
- Comprehensive Examination of Sentinel Lymph Node in Breast Cancer: A Solution Without a Problem?International Journal of Surgical Pathology, 2006
- American Society of Clinical Oncology Guideline Recommendations for Sentinel Lymph Node Biopsy in Early-Stage Breast CancerJournal of Clinical Oncology, 2005
- Nonsentinel node metastases in breast cancer patients with isolated tumor cells in the sentinel node: implications for completion axillary node dissectionThe American Journal of Surgery, 2005
- Prediction of Metastasis to Non‐sentinel Nodes by Sentinel Node Status and Primary Tumor Characteristics in Primary Breast Cancer in TaiwanWorld Journal of Surgery, 2005
- The value of immunohistochemistry in sentinel lymph node histopathology in breast cancerBritish Journal of Cancer, 2005
- Prediction of non-sentinel lymph node status in breast cancer with a micrometastatic sentinel nodeBritish Journal of Surgery, 2005
- Breast cancer patients with pN0(i+) and pN1(mi) sentinel nodes have high rate of nonsentinel node metastasesJournal of the American College of Surgeons, 2005
- Predicting the Risk for Additional Axillary Metastases in Patients With Breast Carcinoma and Positive Sentinel Lymph Node BiopsyAnnals of Surgery, 2005
- Improving the reproducibility of diagnosing micrometastases and isolated tumor cellsCancer, 2005