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Retrospective observational study about reducing the false negative rate of the sentinel lymph node biopsy: Never underestimate the effect of subjective factors.

Abstract Reducing the false negative rate of sentinel lymph node biopsy (SLNB) for breast cancer patients has always been a focus of clinical research. We aimed to map the sentinel lymph nodes (SLNs) in detail, and analyze the factors related to SLNs located at locations that are often ignored by surgeons, to reduce the rate of false negatives from SLNB. A retrospective analysis involving 545 breast cancer patients who underwent SLNB in west China hospital between August 2010 and February 2016 was performed. Blue dye, radioisotope, or combined methods were used for tracing SLNs. Using blue dye, radioisotope, and a combination of blue dye and radioisotope successfully traced SLNs in 479, 507, and 525 patients, the detection rate was 88.2%, 93.9%, and 97.4%, respectively. Among the 1559 detected SLNs, 139 (9.6%) were located at the latissimus dorsi lateral margin, and 108 (6.9%) were located at level 2. Subcutaneous injection of radioisotope (P = .004) and intradermal injection of blue dye (P = .002) were independent factors associated with SLNs distributed at level 2 and the latissimus dorsi lateral margin, respectively. It was noteworthy that 2 of 7 patients had skipping metastasis in level 2, so subcutaneous injection of the isotope is strongly recommended for tracing SLNs distributed in level 2 because of the possibility of skipping metastasis. Though intradermal injection of blue dye was superior methods for tracing SLNs located at the latissimus dorsi lateral margin, we surprisingly found those patients with metastasis to the latissimus dorsi lateral margin nodes also could have metastasis to level 1 (expect for the latissimus dorsi lateral margin) nodes, it seemed that maybe there is no need to excise SLNs at the latissimus dorsi lateral margin in SLNB, whether such nodes should be regarded as useful for SLNB still needs to be determined by further large, multicenter clinical studies.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 28834882
OWN - NLM
STAT- MEDLINE
DA  - 20170823
DCOM- 20170911
LR  - 20170911
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 34
DP  - 2017 Aug
TI  - Retrospective observational study about reducing the false negative rate of the
      sentinel lymph node biopsy: Never underestimate the effect of subjective factors.
PG  - e7787
LID - 10.1097/MD.0000000000007787 [doi]
AB  - Reducing the false negative rate of sentinel lymph node biopsy (SLNB) for breast 
      cancer patients has always been a focus of clinical research. We aimed to map the
      sentinel lymph nodes (SLNs) in detail, and analyze the factors related to SLNs
      located at locations that are often ignored by surgeons, to reduce the rate of
      false negatives from SLNB. A retrospective analysis involving 545 breast cancer
      patients who underwent SLNB in west China hospital between August 2010 and
      February 2016 was performed. Blue dye, radioisotope, or combined methods were
      used for tracing SLNs. Using blue dye, radioisotope, and a combination of blue
      dye and radioisotope successfully traced SLNs in 479, 507, and 525 patients, the 
      detection rate was 88.2%, 93.9%, and 97.4%, respectively. Among the 1559 detected
      SLNs, 139 (9.6%) were located at the latissimus dorsi lateral margin, and 108
      (6.9%) were located at level 2. Subcutaneous injection of radioisotope (P = .004)
      and intradermal injection of blue dye (P = .002) were independent factors
      associated with SLNs distributed at level 2 and the latissimus dorsi lateral
      margin, respectively. It was noteworthy that 2 of 7 patients had skipping
      metastasis in level 2, so subcutaneous injection of the isotope is strongly
      recommended for tracing SLNs distributed in level 2 because of the possibility of
      skipping metastasis. Though intradermal injection of blue dye was superior
      methods for tracing SLNs located at the latissimus dorsi lateral margin, we
      surprisingly found those patients with metastasis to the latissimus dorsi lateral
      margin nodes also could have metastasis to level 1 (expect for the latissimus
      dorsi lateral margin) nodes, it seemed that maybe there is no need to excise SLNs
      at the latissimus dorsi lateral margin in SLNB, whether such nodes should be
      regarded as useful for SLNB still needs to be determined by further large,
      multicenter clinical studies.
FAU - Zhou, Yu-Ting
AU  - Zhou YT
AD  - aDepartment of Breast Surgery bLaboratory of Breast Disease cLaboratory of
      Pathology, West China Hospital, Sichuan University, Chengdu, China.
FAU - Du, Zheng-Gui
AU  - Du ZG
FAU - Zhang, Di
AU  - Zhang D
FAU - Lv, Qing
AU  - Lv Q
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Breast Neoplasms/*pathology
MH  - False Negative Reactions
MH  - Female
MH  - Humans
MH  - Lymphatic Metastasis
MH  - Neoplasm Staging
MH  - Retrospective Studies
MH  - Sentinel Lymph Node/*pathology
MH  - Sentinel Lymph Node Biopsy/*standards
PMC - PMC5572004
EDAT- 2017/08/24 06:00
MHDA- 2017/09/12 06:00
CRDT- 2017/08/24 06:00
AID - 10.1097/MD.0000000000007787 [doi]
AID - 00005792-201708250-00019 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Aug;96(34):e7787. doi: 10.1097/MD.0000000000007787.