> Table 33: Accuracy of sentinel node biopsy in predicting axillary lymph node status
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Introduction: Sentinel node biopsy is an accurate method of determining lymph node status. As shown in the results of the four randomized clinical trials and 19 non-randomized clinical trials listed below, if there is cancer in the axillary lymph nodes, sentinel node biopsy will find it over 90 percent of the time. The experience of the breast surgeon with sentinel node biopsy is critical to its success.
Compared to standard axillary treatment, sentinel lymph node biopsy leads to less post-treatment lymphedema and sensory loss in the arm, as well as a better quality of life in the year after treatment [1,2]. There does not appear to be a difference in survival rates with sentinel node biopsy alone compared to sentinel node biopsy followed by axillary dissection. However, more data are needed to confirm these results [3,4].
Study selection criteria: Randomized clinical trials with at least 100 participants and non-randomized clinical trials in which at least 150 sentinel node biopsies were performed in a row, using the same technique and followed by axillary lymph node dissection.
Table note: Sensitivity in the table below measures how accurately the sentinel node biopsy identified the axillary node status. For example, a sensitivity of 90 percent means that 90 percent of the people the sentinel node biopsy identified as having positive axillary nodes did in fact have axillary node involvement when tested with axillary dissection.
|
Study
|
Study Population
(number of participants)
|
Tumor Stage
|
Method Used
(blue dye, radioactive tracer or combined technique)
|
Accuracy in Predicting Axillary Node Status
Sensitivity %
|
Randomized clinical trials
|
| NSABP B-32 Trial [5] |
2,807
|
T1, T2, T3 |
Combined technique |
90.2% |
| SNAC Trial [6] |
509
|
T1, T2, T3 |
Blue dye alone or combined technique |
94.5% |
| Sentinella/GIVOM Trial [4] |
352 |
T1, T2 |
Radioactive tracer alone
|
83.3% |
| Veronesi et al. [7] |
100 |
T1 |
Radioactive tracer alone |
91.2% |
| Radovanovic et al. [8] |
100 |
T1, T2, N0 |
Combined technique |
83% |
| Clinical trials (non-randomized) |
| Kuehn et al. [9] |
1,124 |
All tumor stages
|
Combined technique |
91.8% |
| Martin et al. [10] |
758 |
T1, N0 or T2, N0 |
Combined technique |
94.2% |
| Swedish Breast Cancer Group [11] |
675 |
T1, T2, T3 |
Combined technique |
94.5% |
| Krag et al. [12] |
443 |
All tumor stages |
Radioactive tracer alone |
88.6% |
Veronesi et al. [13]
|
376
|
T1, T2, T3 |
Radioactive tracer alone |
93.3%
|
| Nano et al. [14] |
328 |
N0 |
Combined technique |
97.2% |
| Schrenk et al. [15] |
263 |
T1, T2 |
Combined technique |
99% |
| Koizumi et al. [16] |
200 |
T1, T2 |
Radioactive tracer alone |
95-99%* |
Cserni et al. [17]
|
199
|
T1, T2, N0
|
Combined technique
|
97.7%
|
Asoglu et al. [18]
|
162
|
T1, T2, N0
|
Blue dye alone
|
94.2%
|
Meta-analysis
|
Kim et al. [19]
|
8,059
|
Not available
|
Blue dye alone, radioactive tracer or combined technique
|
96.4%
|
Xing et al. [20]
|
1,273
|
Not available
|
Blue dye alone, radioactive tracer or combined technique
|
90%
|
* This study compared two different types of radioactive tracers (Therefore there are two values of sensitivity, one for each tracer.)
References
- Mansel RE, Fallowfield L, Kissin M, et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial. J Natl Cancer Inst. 3;98(9):599-609, 2006.
- Langer I, Guller U, Berclaz G, et al. Morbidity of sentinel lymph node biopsy (SLN) alone versus SLN and completion axillary lymph node dissection after breast cancer surgery: a prospective Swiss multicenter study on 659 patients. Ann Surg. 245(3):452-61, 2007.
- Veronesi U, Paganelli G, Viale G, et al. Sentinel-lymph-node biopsy as a staging procedure in breast cancer: update of a randomised controlled study. Lancet Oncol. 7(12):983-90, 2006.
- Zavagno G, De Salvo GL, Scalco G, et al. for the GIVOM Trialists. A randomized clinical trial on sentinel lymph node biopsy versus axillary lymph node dissection in breast cancer: results of the Sentinella/GIVOM trial. Ann Surg. 247(2):207-13, 2008.
- Krag DN, Anderson SJ, Julian TB, et al. for the National Surgical Adjuvant Breast and Bowel Project Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial. Lancet Oncol. 8(10):881-8, 2007.
- Gill G for the SNAC Trial Group of the Royal Australasian College of Surgeons (RACS) and NHMRC Clinical Trials Centre. Sentinel-lymph-node-based management or routine axillary clearance? One-year outcomes of sentinel node biopsy versus axillary clearance (SNAC): a randomized controlled surgical trial. Ann Surg Oncol. 16(2):266-75, 2009.
- Veronesi U, Paganelli G, Viale G, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med. 349: 546-53, 2003.
- Radovanovic Z, Golubovic A, Plzak A, et al. Blue dye versus combined blue dye-radioactive tracer technique in detection of sentinel lymph node in breast cancer. Eur J Surg Oncol. 30(9):913-7, 2004.
- Kuehn T, Vogl FD, Helms G, Pueckler SV, Schirrmeister H, Strueber R, Koretz K, Kreienberg R; German multi-institutional trial. Sentinel-node biopsy for axillary staging in breast cancer: results from a large prospective German multi-institutional trial. Eur J Surg Oncol. 30(3):252-9, 2004.
- Martin RCG II, Edwards MJ, Wong SL, et al. Practical guidelines for optimal gamma probe detection of sentinel lymph nodes in breast cancer: results of a multi-institutional study. Surgery. 128(2):139-144, 2000.
- Bergkvist L, Frisell J on behalf of the Swedish Breast Cancer Group and the Swedish Society of Breast Surgeons. Multicentre validation study of sentinel node biopsy for staging in breast cancer. Br J Surg. 92(10):1221-4, 2005.
- Krag D, Weaver D, Ashikaga T, et al. The sentinel node in breast cancer--a multicenter validation study. N Engl J Med. 339(14):941-946, 1998.
- Veronesi U, Paganelli G, Viale G, et al. Sentinel Lymph node biopsy and axillary dissection in breast cancer: results in a large series. J Natl Cancer Inst. 91(4): 368-373, 1999.
- Nano MT, Kollias J, Farshid G, Gill PG, Bochner M. Clinical impact of false-negative sentinel node biopsy in primary breast cancer. Br J Surg. 89(11):1430-4, 2002.
- Schrenk P, Rehberger W, Shamiyeh A, Wayand W. Sentinel node biopsy for breast cancer: does the number of sentinel nodes removed have an impact on the accuracy of finding a positive node? J Surg Oncol. 80(3):130-6, 2002.
- Koizumi M, Nomura E, Yamada Y, et al. Radioguided sentinel node detection in breast cancer patients: comparison of 99mTc phytate and 99mTc rhenium colloid efficacy. Nucl Med Commun. 25(10):1031-7, 2004.
- Cserni G, Rajtar M, Boross G, Sinko M, Svebis M, Baltas B. Comparison of vital dye-guided lymphatic mapping and dye plus gamma probe-guided sentinel node biopsy in breast cancer. World J Surg. 26(5):592-7, 2002.
- Asoglu O, Ozmen V, Karanlik H, et al. The role of sentinel lymph node biopsy with blue dye alone in breast cancer patients with excisional biopsy. Acta Chir Belg. 105(3):291-6, 2005.
- Kim T, Giuliano AE, Lyman GH. Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: A metaanalysis. Cancer. 106(1):4-16, 2006.
- Xing Y, Foy M, Cox DD, et al. Meta-analysis of sentinel lymph node biopsy after preoperative chemotherapy in patients with breast cancer. Br J Surg. 93(5):539-46, 2006.
Updated 09/12/09
