Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
J Breast Cancer. 2011 Dec;14(4):296-300. doi: 10.4048/jbc.2011.14.4.296. Epub 2011 Dec 27.
During a sentinel lymph node biopsy (SLNB) for breast cancer, the appropriate number of sentinel lymph nodes (SLNs) to be removed for accurate axillary staging is still controversial. We hypothesized that there might be an optimal threshold number of SLNs. We investigated how many SLNs should be removed to achieve an acceptable accuracy and ensure minimal morbidity.
We reviewed data of 328 patients with invasive breast cancer who underwent SLNB followed by complete level I and II axillary dissection between January 2004 and December 2005. The false negative rate (FNR) and accuracy of SLNB according to the number of removed SLNs were evaluated.
The mean number of SLNs removed was 3.0 (range, 1-14), and that of total retrieved axillary lymph nodes was 17.5 (range, 10-40). In total, 111 (33.8%) patients had positive nodes on the permanent pathological report. Among them, 12 patients had negative SLNs; thus, the overall FNR of SLNB was 10.8% (12/111) and the accuracy was 96.3% (316/328). The FNR was 26.6% for a single SLN, 8.0% for two, and 11.1% for three. In cases where four or more SLNs were removed, the FNR decreased to 0% and accuracy reached 100%.
Our data suggest that a SLNB should not only remove one or two of the hottest node(s) when other hot nodes exist. We also suggest that four might be an optimal threshold number of SLNs to be removed and that removal of more than four SLNs does not improve axillary staging accuracy.
在乳腺癌前哨淋巴结活检（SLNB）中，为准确进行腋窝分期而切除的前哨淋巴结（SLN）数量仍存在争议。我们假设可能存在最佳的 SLN 切除数量阈值。我们研究了需要切除多少个 SLN 才能达到可接受的准确性并确保最小的发病率。
我们回顾了 2004 年 1 月至 2005 年 12 月期间接受 SLNB 后行完全 I 级和 II 级腋窝清扫术的 328 例浸润性乳腺癌患者的数据。根据切除的 SLN 数量评估 SLNB 的假阴性率（FNR）和准确性。
平均切除的 SLN 数量为 3.0（范围，1-14），总取出的腋窝淋巴结数量为 17.5（范围，10-40）。共有 111 例（33.8%）患者的永久性病理报告显示有阳性淋巴结。其中 12 例患者的 SLN 为阴性；因此，SLNB 的总 FNR 为 10.8%（12/111），准确性为 96.3%（316/328）。单个 SLN 的 FNR 为 26.6%，两个为 8.0%，三个为 11.1%。当切除四个或更多 SLN 时，FNR 降至 0%，准确性达到 100%。
我们的数据表明，SLNB 不仅应切除其他热点淋巴结存在时的一个或两个热点淋巴结。我们还建议，切除四个 SLN 可能是最佳的切除数量阈值，切除四个以上的 SLN 不会提高腋窝分期的准确性。
