Clinical Experience for Sentinel Lymphadenectomy Alone in Early Breast Cancer / 한국유방암학회지

PURPOSE: This study was performed to evaluate the efficacy and safety of sentinel lymph node biopsy alone (SLNB) without axillary lymph node dissection. METHODS: Between Jun. 1999 and Dec. 2002, we carried out SLNB in 85 consecutive patients with T1 breast cancer whose sentinel lymph node(s) were tumor-free on intra- operative frozen section. Even when sentinel lymph node(s) turned out to be positive by permanent pathology, additional axillary lymph node dissection was not performed. Patients underwent total mastectomy or partial mastectomy and received an appropriate adjuvant therapy according to the characteristics of the primary tumor. All patients who had breast conserving surgery received postoperative radiotherapy to the remaining breast, but not to the axilla. RESULTS: SLNB only took 14 minutes and yielded no postoperative complications. Among the 85 patients whose sentinel lymph nodes were tumor-free on frozen section, 11 patients were diagnosed as metastatic in the permanent pathology. One of them had a macro-metastasized (2.5 cm) sentinel lymph node, and the rest had micro-metastasized sentinel lymph nodes. For 23.1 months of mean follow-up period, all the patients including a patient who died of liver metastases at 17 months showed no evidence of axillary recurrence. CONCLUSION: No axillary recurrence following SLNB suggests that SLNB may be a good alternative to routine axillary lymph node dissection while providing less surgical morbidity in women with a small breast cancer. However, more patients accumulation and follow-up period will be needed for the final conclusion.

The Necessity of Learning Period for Sentinel Lymphadenectomy in Breast Carcinoma / 한국유방암학회지

PURPOSE: Although an axillary lymph node dissection (ALND) has been considered as an ultimate procedure for axilla in the breast carcinoma, complications after ALND and conceptual revolution for the role of axillary nodes have made it necessary to look for an alternative. Recent studies of sentinel lymphadenectomy (SLND) have shown that SLND accurately predict axillary nodal status. However, for a satisfying outcome in SLND, a learning period would be required, as other surgical procedures do. In this study, the necessity of the learning period for SLND were examined. METHODS: From Nov. 1998 to Dec. 2001, 178 patients with invasive breast carcinoma were treated with SLND simultaneously followed by ALND. The period for the first 54 patients, Nov. 1998 to May. 1999, was set as a 'learning period'. Differences of the detection rate and the false negative rate for the 'learning period' and 'after the learning period' were compared. Also changes in the detection rate and the false negative rate with the accumulated experiences for SLND were evaluated. RESULTS: The sentinel lymph nodes were not identified in 5 patients through the whole period. Three of them occurred in the 'learning period' (5.6%, 3/54) and the rest occurred 'after the learning period' (1.6%, 2/124)(P=0.04). The false negative rate was 16.7% (4/24) in the 'learning period' and 0.0% in 'after the learning period' (P=0.00). The detection rate and the false negative rate improved with the accumulation of experiences for SLND. CONCLUSION: It is certain that 'learning period' for SLND is crucial. During this period, the improvement and stabilization of this skill is achieved.