Application Of Sentinel Lymph Node Biopsy Following Sentinel Lymph Channel In Directing Selective Axillary Lymph Node Dissection

Objective: To identify the status of sentinel lymph nodes(SLNs) and direct selective axillary lymph node dissection (ALND) according to the results of sentinel lymph node biopsy (SLNB) technique following sentinel lymph channel (SLC),so that some patients can avoid ALND and relational complications.Methods: In this prospective non-randomized study, all patients received SLNB following SLC with combinative or dye tracer method. All SLNs were investigated by frozen section and touch cytology intraoperatively. Patients in Group A received selective ALND according to the intraoperative pathologic results of SLNs, Patients in Group A1 received ALND when the SLNs were positive, patients in Group A2 received SLNB only in case of negative SLNs; and all patients in Group B received ALND following SLNB whatever the status of SLNs were. All lymph nodes dissected were detected by hematoxylin-eosin(HE)staining postoperatively.Results:From Jul. 2008 to Dec. 2009, 123 patients with early breast cancer received SLNB and 121 patients'SLNs were identified successfully. 32, 29 and 60 patients were selected as Group A1, A2 and B, respectively. The dissection rates of SLNB with combinative and dye tracer method were 98.2%(109/111) and 100%(12/12) ( P=1.000), respectively. The false negative rate of SLNB was 3.2%(2/62) in the patients receiveing ALND(A1+B). The number of SLN harvested by SLNB was 1~4 with a tot of 157 and an average of 1.3 per patient. 63 SLNs were found positive,with 32, 1 and 30 in group A1, groupA2 and group B,respectively. 54 positive SLNs were found by intraoperative frozen section, with 29 and 25 in group A1 and group B ,respectively. 56 positive SLNs were detected by intraoperative touch cytology, with 30 and 26 in group A1 and group B, respectively. 59 positive SLNs were discovered by joint pathological detection, with 32 and 27 in group A1 and group B ,respectively. The sensitivity of frozen section,touch cytology and joint pathological detection were 85.7%(54/63), 88.9%(56/63) and93.7%(59/63), respectively(P=0.346). It's worth noting that we found a few normal epithelial cells by touch cytology in a patient. The complication rate for ALND(56.5%) was higher than that for SLNB(10.3%)(P=0.000).Conclusions: The SLNB technique following SLC could localize SLN accurately, decrease the false negative rate notably, direct selective ALND efficiently and decrease the complication. Futher study is required to solve the problems such as whether ductal carcinoma in situ(DCIS) need SLNB, sensitive and economic intraoperative pathological diagnostic method and the mean of the false positive of SLNB.