Skip to main content
SpringerLink
Log in

A multicenter validation study of sentinel lymph node biopsy by the Japanese Breast Cancer Society

  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Several pilot studies have indicated that SLN biopsy can be used to identify axillary lymph node metastases in patients with breast cancer. To confirm this finding, a multicenter study in a variety of practice settings was performed. A total of 674 patients with breast cancer at five institutions were enrolled. The techniques of SLN identification included the vital dye-guided and the vital dye- and gamma probe-guided methods. The SLN was removed, and complete axillary lymph node dissection (ALND) was performed. SLN and ALND specimens were examined separately. The SLN was successfully identified in 214 (94%) of 227 patients using the combined dye- and gamma probe-guided methods. The SLN was identified in 332 (74%) of 447 patients using vital dye-guided method alone. Patient age of at least 51 years, medially located primary tumor, and clinically positive nodes were correlated with failure to identify the SLN. The accuracy of SLN biopsy for the detection of metastatic disease was 96% (522 of 546), and the sensitivity was 90% (203 of 226). Accuracy of 100% was achieved in the patients with tumors less than 1.6 cm in diameter. All 23 false negative results occurred with larger primary tumors. SLN biopsy can accurately predict the presence or absence of axillary lymph node metastases, particularly in patients with small (≤ 1.5 cm) breast cancers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Senofsky GM, Moffat FL Jr, Davis K, et al.: Total axillary lymphadenectomy in the management of breast cancer. Arch Surg 126: 1336-1342, 1991

    Google Scholar 

  2. Fentiman IS, Mansel RE: The axilla: not a no-go zone. Lancet 337: 221-223, 1991

    Google Scholar 

  3. Noguchi M, Miwa K, Michigishi T, et al.: The role of axillary lymph node dissection in breast cancer management. Breast Cancer 4: 143-153, 1997

    Google Scholar 

  4. Fisher B, Redmond C, Fisher ER, et al.: Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation. N Engl J Med 312: 674-681, 1985

    Google Scholar 

  5. Lythgoe JP, Palmer MK: Manchester regional breast study - 5 and 10 years results. Br J Surg 69: 693-696, 1982

    Google Scholar 

  6. Cancer Research Campaign Work Party: Cancer Research Campaign (King's Cambridge) trial for early breast cancer. Lancet 2: 55-60, 1980

    Google Scholar 

  7. Kissin MW, Querci della Rovere G, Easton D, et al.: Risk of lymphedema following the treatment of breast cancer. Br J Surg 73: 580-585, 1986

    Google Scholar 

  8. Noguchi M, Katev N, Miyazaki I: Diagnosis of axillary lymph node metastases in patients with breast cancer. Breast Cancer Res Treat 40: 283-293, 1996

    Google Scholar 

  9. Krag DN, Weaver OJ, Alex JC, et al.: Surgical resection and radiolocalization of the sentinel node in breast cancer using a gamma probe. Surg Oncol 2: 335-340, 1993

    Google Scholar 

  10. Giuliano AE, Kirgan DM, Guenther JM, et al.: Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg 220: 391-401, 1994

    Google Scholar 

  11. Albertini JA, Lyman GH, Cox C, et al.: Lymphatic mapping and sentinel node biopsy in the patients with breast cancer. J Am Med Assoc 276: 1818-1822, 1996

    Google Scholar 

  12. Cabanas RM: An approach for the treatment of penile carcinoma. Cancer 39: 456-466, 1997

    Google Scholar 

  13. Morton DL, Wen DR, Wong JH, et al.: Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 127: 392-399, 1992

    Google Scholar 

  14. Alex JC, Krag DN: Gamma-probe guided localization of lymph nodes. Surg Oncol 2: 137-143, 1993

    Google Scholar 

  15. Turner RR, Ollila DW, Krasne DL, et al.: Histopathological validation of the sentinel lymph node hypothesis for breast carcinoma. Ann Surg 226: 271-278, 1997

    Google Scholar 

  16. Veronesi U, Paganelli G, Galimberti V, et al.: Sentinel node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph node. Lancet 349: 1864-1867, 1997

    Google Scholar 

  17. Cody HS III: Sentinel lymph node mapping in breast cancer. Breast Cancer 6: 13-22, 1999

    Google Scholar 

  18. Japan Breast Cancer Society: General rules for clinical and pathological recording of breast cancer. 12th edition. Tokyo: Kanehara, 1996, pp 19-34

    Google Scholar 

  19. International Union Against Cancer (UICC): Breast tumors (ICD-0 C-50). In: Sobin LH and Wittekind Ch (eds) TNM Classification of Malignant Tumours, 5th edn, John Wiley & Sons, New York, 1997, pp 123-130.

    Google Scholar 

  20. Cox CE, Pendas S, Joseph E, et al.: Guidelines for sentinel node biopsy and lymphatic mapping of patients with breast cancer. Ann Surg 227: 645-653, 1998

    Google Scholar 

  21. Noguchi M, Tsugawa K, Kawahara F, et al.: Dye-guided sentinel lymphadenectomy in clinically node-negative and nodepositive breast cancer patients. Breast Cancer 5: 381-387, 1998

    Google Scholar 

  22. Motomura K, Inaji H, Komoike Y, et al.: Sentinel node biopsy in breast cancer with clinically negative lymph-nodes. Breast Cancer 6; 259-262, 1999

    Google Scholar 

  23. Imoto S, Hasebe T: Initial experience with sentinel node biopsy in breast cancer at the National Cancer Center Hospital East. Jpn J Clin Oncol 29: 11-15, 1999

    Google Scholar 

  24. Noguchi M, Bando E, Tsugawa K, et al.: Staging efficacy of breast cancer with sentinel lymphadenectomy. Breast Cancer Res Treat 57: 221-229, 1999

    Google Scholar 

  25. Sato K, Hiraide H, Uematsu M, et al.: Efficacy and significance of sentinel lymph node identification with technetium-99m-labeled tin colloids for breast cancer. Breast Cancer 5: 389-393, 1998

    Google Scholar 

  26. The World Health Organization: The World Health Organization histological typing of breast tumors. Am J Clin Pathol 78: 806-816, 1982

    Google Scholar 

  27. Giuliano AE: Sentinel lymphadenectomy in primary breast carcinoma: an alternative to routine axillary dissection. J Surg Oncol 62: 75-77, 1996

    Google Scholar 

  28. O'Hea BJ, Hill ADK, El-Shirbiny AM, et al.: Sentinel lymph node biopsy in breast cancer: Initial experience at Memorial Sloan-Kettering Cancer Center. J Am Coll Surg 186: 423-427, 1998

    Google Scholar 

  29. Cody HS III: Sentinel lymph node mapping in breast cancer. Breast Cancer 6: 13-22, 1999

    Google Scholar 

  30. Borgstein PJ, Pijpers R, Comans FF, et al.: Sentinel lymph node biopsy in breast cancer: Guidelines and pitfalls of lym phoscintigraphy and gamma probe detection. J Am Coll Surg 186: 275-283, 1998

    Google Scholar 

  31. Roumen RMH, Valkenburg JGM, Geuskens LM: Lymphoscintigraphy and feasibility of sentinel node biopsy in 83 patients with primary breast cancer. Eur J Surg Oncol 23: 495-502, 1997

    Google Scholar 

  32. Pijpers R, Meijer S, Hoekstra OS, et al.: Impact of lymphoscintigraphy on sentinel node identification with Technetium-99m-colloidal albumin in breast cancer. J Nucl Med 38: 366-368, 1997

    Google Scholar 

  33. Paganelli G, De Cicco C, Cremonesi M, et al.: Optimized sentinel node scintigraphy in breast cancer. Q J Nucl Med 42: 49-53, 1998

    Google Scholar 

  34. Noguchi M, Tsugawa K, Bando E, et al.: Sentinel lymphadenectomy in breast cancer: identification of sentinel lymph node and detection of metastases. Breast Cancer Res Treat 53: 97-104, 1999

    Google Scholar 

  35. Strand SE, Persson BRR: Quantitative lymphoscintigraphy: basic concepts for optimal uptake of radiocolloids in the parasternal lymph nodes of rabbits. J Nucl Med 20: 1038-1046, 1979

    Google Scholar 

  36. Gulec SA, Moffat FL, Carroll RG, Krag DN: Gamma probe guided sentinel node biopsy in breast cancer. GJ Nucl Med 41: 251-261, 1997

    Google Scholar 

  37. Krag DN, Ashikaga T, Harlow SP, Weaver DL: Development of sentinel node targeting technique in breast cancer patients. Breast 4: 67-74, 1998

    Google Scholar 

  38. Harlow S, Krag D, Weaver D, Ashikaga T: Extra-axillary sentinel lymph nodes in breast cancer. Breast Cancer 6: 159-165, 1999

    Google Scholar 

  39. Giuliano AE, Dale PS, Turner RR, et al.: Improved axillary staging of breast cancer with sentinel lymphadenectomy. Ann Surg 222: 394-401, 1995

    Google Scholar 

  40. Galimberti V, Zurrida S, Zucali P, Luini A: Can sentinel node biopsy avoid axillary dissection in clinically node-negative breast cancer patients? Breast 7: 8-10, 1998

    Google Scholar 

  41. Viale G, Bosari S, Mazzarol G, et al.: Intraoperative examination of axillary sentinel lymph nodes in breast carcinoma patients. Cancer 85: 2433-2438, 1999

    Google Scholar 

  42. Offodile R, Hoh C, Barsky SH, et al.: Minimally invasive breast carcinoma staging using lymphatic mapping with radiolabelled dextran. Cancer 82: 1704-1708, 1998

    Google Scholar 

  43. Krag D, Weaver D, Ashikaga T, et al.: The sentinel node in breast cancer. A multicenter validation study. New Engl J Med 339: 941-946, 1998

    Google Scholar 

  44. Noguchi M: Comment on 'Improved axillary staging of breast cancer with sentinel lymphadenectomy'. Ann Surg 225: 126-127, 1997

    Google Scholar 

  45. Veronesi U, Cascinelli N, Greco M, et al.: Prognosis of breast cancer patients after mastectomy and dissection of internal mammary nodes. Ann Surg 202: 702-707, 1985

    Google Scholar 

  46. Noguchi M, Tsugawa K, Miwa K, et al.: Internal mammary chain sentinel lymph node identification in breast cancer. J Surg Oncol 73: 75-80, 2000

    Google Scholar 

  47. Veronesi U, Valagussa P: Inefficacy of internal mammary nodes dissection in breast cancer surgery. Cancer 47: 170-175, 1981

    Google Scholar 

  48. Kramer EL: Lymphoscintigraphy: radiopharmaceutical selection and methods. Nucl Med Biol 17: 57-63, 1990

    Google Scholar 

  49. Veronesi U, Zurrida S, Galimberti V: Consequences of sentinel node in clinical decision making in breast cancer and prospects for future studies. Eur J Surg Oncol 24: 93-95, 1998

    Google Scholar 

  50. Veronesi U: Sentinel-node biopsy in breast cancer. Lancet 350: 808-809, 1997

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Operation Center, Saitama, Japan

    Masakuni Noguchi

  2. Department of Surgery (II), Kanazawa University Hospital, Kanazawa, Japan

    Masakuni Noguchi & Koichirou Tsugawa

  3. Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan

    Kazuyoshi Motomura

  4. Division of Breast Surgery, National Cancer Center East Hospital, Kashiwara, Japan

    Shigeru Imoto

  5. Division of Breast Surgery, Chiba Cancer Center, Chiba, Japan

    Mitsuru Miyauchi

  6. Department of Surgery (I), National Defence Medical College, Tokorozawa, Japan

    Kazuhiko Sato

  7. Division of Breast Surgery, Aichi Cancer Center, Nagoya, Japan

    Hiroji Iwata

  8. Department of Surgery, Tokai University Tokyo Hospital, Tokyo, Japan

    Masatoshi Ohta

  9. Division of Pathology, Saitama Cancer Center, Saitama, Japan

    Masafumi Kurosumi

Authors
  1. Masakuni Noguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kazuyoshi Motomura
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shigeru Imoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mitsuru Miyauchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kazuhiko Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hiroji Iwata
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Masatoshi Ohta
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Masafumi Kurosumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Koichirou Tsugawa
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Noguchi, M., Motomura, K., Imoto, S. et al. A multicenter validation study of sentinel lymph node biopsy by the Japanese Breast Cancer Society. Breast Cancer Res Treat 63, 31–40 (2000). https://doi.org/10.1023/A:1006428105579

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1006428105579

Search

Navigation