A critical review of variables affecting the accuracy and false-negative rate of sentinel node biopsy procedures in early breast cancer

2005 ◽  
Vol 26 (5) ◽  
pp. 395-405 ◽  
Author(s):  
Vani Vijayakumar ◽  
Philip S. Boerner ◽  
Ashesh B. Jani ◽  
Srinivasan Vijayakumar
Keyword(s):  
Breast Cancer ◽  
Sentinel Node ◽  
Sentinel Node Biopsy ◽  
Early Breast Cancer ◽  
Critical Review ◽  
False Negative ◽  
False Negative Rate ◽  
Node Biopsy ◽  
Negative Rate

Post-neoadjuvant chemotherapy sentinel node biopsy and axillary sampling for node negative (N0) axilla.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1108-1108
Author(s):  
Vani Parmar ◽  
Nita S. Nair ◽  
Rohini W Hawaldar ◽  
Vaibhav Vanmali ◽  
Aruna Laxman Prabhu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Sentinel Node ◽  
Sentinel Node Biopsy ◽  
False Negative ◽  
False Negative Rate ◽  
Advanced Breast ◽  
Node Negative ◽  
Node Biopsy ◽  
Negative Rate

1108 Background: Post neoadjuvant chemotherapy (NACT) sentinel node biopsy (SNB) is not a standard of care due to the wide variability in false negative rate (FNR), varying from 5.7% to 33%. In operable breast cancer (OBC), FNR of less than 10% is acceptable. We attempted to find out the reliability of low axillary sampling(LAS), with dissection limited below the first intercostobrachial nerve, to correctly identify the node negative axilla in the post NACT clinically node negative (N0) patients. Methods: Women with large operable (LOBC) and locally advanced breast cancer (LABC), post-NACT clinically N0, underwent concomitant blue dye-colloid guided SNB and LAS. The identification rate, FNR, and negative predictive value (NPV) of both procedures were compared. Results: Post-NACT 209 eligible women underwent combined LAS and SNB procedure. At presentation, the tumors were large (median 5.0 cm) with 70% clinically palpable nodes. All patients received 4 cycles of neo-adjuvant anthracycline-based chemotherapy and were clinically node negative after chemotherapy. SNB was defined as blue and/or hot node plus palpable node(s). A blue or hot node (median 2 nodes) was identified in 93.8%, and median of 5 sentinel nodes were removed. The false negative rate of SNB was 15.3% (95% CI 8.7%-25.3%). The LAS technique comparatively had nodal yield in 98.5% with median 8 nodes removed; and FNR 8.5% (95% CI, 4.2%-16.6%, p=0.19). Comparative NPV for LAS and SNB were 94.6% and 91.8% respectively. Conclusions: Axillary sampling results for FNR and NPV are similar if not superior to SNB and could be a reliable method of axillary nodal evaluation in advanced breast cancers following neo-adjuvant chemotherapy.

scholarly journals Sentinel node biopsy in vulvar cancer: A critical appraisal

2017 ◽  
Vol 03 (01) ◽  
pp. 005-011
Author(s):  
Neville Hacker ◽  
Ellen Barlow
Keyword(s):  
Sentinel Node ◽  
Sentinel Node Biopsy ◽  
Vulvar Cancer ◽  
False Negative ◽  
False Negative Rate ◽  
Groin Dissection ◽  
Loss Of Life ◽  
Risks And Benefits ◽  
Node Biopsy ◽  
Negative Rate

AbstractSince the incorporation of inguinal-femoral lymphadenectomy into the management of patients with vulvar cancer in the mid-20th century, there have been attempts to modify or eliminate the groin dissection to decrease the risk of lower limb lymphedema. Early attempts were significantly flawed and resulted in much unnecessary loss of life because recurrence in an undissected groin is usually fatal. The best compromise yet to decrease the risk of lymphedema is sentinel node biopsy, but accumulated evidence now suggests that the false-negative rate for this procedure, if used for lesions up to 4 cm in diameter, is between 5% and 10%. Most women, properly informed of risks and benefits, are not prepared to take a 1% risk of dying from recurrent vulvar cancer to avoid lymphedema. This is the risk involved, assuming a false-negative rate of 5% and an incidence of positive nodes of 20%. For this reason, sentinel node biopsy should not be considered to be standard practice for patients with early vulvar cancer.

The Predictive Value of Sentinel Lymph Node Biopsy in Locally Advanced Breast Cancer Patients who Have Undergone Neoadjuvant Chemotherapy

2007 ◽  
Vol 73 (10) ◽  
pp. 977-980 ◽  
Author(s):  
Maki Yamamoto ◽  
Rita S. Mehta ◽  
Choong H. Baick ◽  
Min-Ying Su ◽  
Karen T. Lane ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Sentinel Node ◽  
Sentinel Node Biopsy ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
False Negative ◽  
False Negative Rate ◽  
Axillary Node ◽  
Node Biopsy

With the increasing usage of neoadjuvant chemotherapy (NAC) in locally advanced breast cancer (LABC), there is the need to investigate the routine axillary node dissections performed in this group of patients. Controversy exists about the utility of sentinel node biopsy (SNB), either before or after NAC. With the addition of trastuzumab in the treatment of Her2/neu-positive LABC patients, the validity of SNB in this subset population needs to be investigated. A retrospective study of 20 patients who underwent NAC for LABC was undertaken. The pathology of the axillary nodes, sentinel nodes, and primary tumor after neoadjuvant chemotherapy were examined. Twenty patients underwent NAC with doxorubicin and cyclophosphamide, followed sequentially by paclitaxel and carboplatin, with or without trastuzumab based on Her2/neu status. Post chemotherapy, 20 patients underwent mastectomy or lumpectomy with SNB with axillary node dissections. The overall accuracy of SNB was 95 per cent with a false-negative rate of 14 per cent (1/7). In Her2/neu-positive patients, overall accuracy was 100 per cent (8/8) and a false-negative rate of zero per cent. Sentinel node biopsy is a viable option in patients who have undergone NAC. Her2/neu-positive patients who had undergone NAC with trastuzumab had comparable accuracy for sentinel node biopsy in predicting axillary node status.

Optimal timing of radioactive tracer for sentinel node biopsy in breast cancer patients

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 611-611
Author(s):  
N. P. Reuter ◽  
M. R. Bower ◽  
C. R. Scoggins ◽  
R. C. Martin ◽  
K. M. McMasters ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Sentinel Node ◽  
Cancer Patients ◽  
Sentinel Node Biopsy ◽  
False Negative ◽  
False Negative Rate ◽  
Axillary Node ◽  
Optimal Timing ◽  
Breast Cancer Patients ◽  
Node Biopsy

611 Background: While sentinel node biopsy (SNB) is well established as a minimally invasive means of staging the axilla in breast cancer patients, the optimal timing of injection of technetium 99m sulfur colloid (Tm) for SNB remains unclear. Methods: In a prospective multicenter study of 4131 patients who had a SNB for breast cancer followed by axillary node dissection, 3305 patients had a SNB using Tm with the elapsed time from injection to SNB being recorded. These 3305 patients formed the cohort of interest for this study. The dose of Tm remaining at the time of SNB was calculated with the formula mCiremaining=mCiinjected*0.5^(elapsed hours/6). Patients with injection of Tm ≤12h and >12h were compared using SPSS. Results: The mean age of the 3305 patients in this study was 60 years, with a mean tumor size of 1.8 cm. A sentinel node (SN) was identified in 95% of patients. SN identification (ID) was not affected by mCi injected (p=0.88), mCi remaining at time of SNB (p=0.13), or type of Tm (filtered vs. unfiltered, p=0.37). There was a statistically non-significant trend of more SN's removed in the ≤12h group (3.2 vs. 2.5, p=0.06). False negative rate was not affected by mCi injected (p=0.39), mCi remaining at time of SNB (p=0.24), or type of Tm (filtered vs. unfiltered, p=1.00). The overall false negative (FN) rate was 8.0%. Of the 3305 patients in this study, 3221 were injected ≤12h prior to SNB and 84 were injected >12h prior to SNB. For the patients injected ≤12h compared to >12h, there was no difference in SN ID rate, FN rate, counts of the hottest node, or background counts despite more mCi injected and less mCi remaining at SNB in the >12h cohort (see Table). Conclusions: Injecting Tm >12h prior to SNB has an acceptable SN identification rate, and the FN rate was not significantly different than injecting Tm ≤12h prior to SNB. [Table: see text] No significant financial relationships to disclose.

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