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The Effect of Sentinel Node Tumor Burden on Non–Sentinel Node Status and Recurrence Rates in Breast Cancer

¹ Department of Surgery, University of California San Francisco Medical Center at Mount Zion, and University of California San Francisco Comprehensive Cancer Center, 1600 Divisadero Street, San Francisco, California 94143-1674
² Department of Pathology, Box 0102, University of California San Francisco Medical Center, Room M-551, San Francisco, California 94143-0102
³ Departments of Radiology and Epidemiology and Biostatistics, and University of California San Francisco Comprehensive Cancer Center, University of California, San Francisco, CA 94143-0946
⁴ Department of Nuclear Medicine, University of California San Francisco Medical Center at Mount Zion, 1600 Divisadero Street, San Francisco, California 94143-1667

Correspondence: Address correspondence and reprint requests to: Stanley P. L. Leong, MD; E-mail: leongs{at}surgery.ucsf.edu.

Background: Routine axillary lymph node dissection (ALND) after selective sentinel lymphadenectomy (SSL) in the treatment of breast cancer remains controversial. We sought to determine the need for routine ALND by exploring the relationship between sentinel lymph node (SLN) and non-SLN (NSLN) status. We also report our experience with disease relapse in the era of SSL and attempt to correlate this with SLN tumor burden.

Methods: This was a retrospective study of 390 patients with invasive breast cancer treated at a single institution who underwent successful SSL from November 1997 to November 2002.

Results: Of the 390 patients, 115 received both SSL and ALND. The percentage of additional positive NSLNs in the SLN-positive group (34.2%) was significantly higher than in the SLN-negative group (5.1%; P = .0004). The SLN macrometastasis group had a significantly higher rate of positive NSLNs (39.7%) compared with the SLN-negative group (5.1%; P = .0001). Sixteen patients developed recurrences during follow-up, including 6.1% of SLN-positive and 3.3% of SLN-negative patients. Among the SLN macrometastasis group, 8.7% had recurrence, compared with 2.2% of SLN micrometastases over a median follow-up period of 31.1 months. One regional failure developed out of 38 SLN-positive patients who did not undergo ALND.

Conclusions: ALND is recommended for patients with SLN macrometastasis because of a significantly higher incidence of positive NSLNs. Higher recurrence rates are also seen in these patients. However, the role of routine ALND in patients with a low SLN tumor burden remains to be further determined by prospective randomized trials.

Key Words: Sentinel lymph node • Non–sentinel node status • Tumor burden • Recurrence

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