Factors affecting failed localisation and false-negative rates of sentinel node biopsy in breast cancer : results of the ALMANAC validation phase
Despite the widespread application of sentinel lymph node biopsy (SLNB) for early stage breast cancer, there is a wide variation in reported test performance characteristics. A major aim of this prospective multicentre validation study was to quantify detection and false-negative rates of SLNB and e...
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| description | Despite the widespread application of sentinel lymph node biopsy (SLNB) for early stage breast cancer, there is a wide variation in reported test performance characteristics. A major aim of this prospective multicentre validation study was to quantify detection and false-negative rates of SLNB and evaluate factors influencing them.
Eight-hundred and fourty-two patients with clinically node-negative breast cancer underwent SLNB according to a standardised protocol that used a combination of radiopharmaceutical 99mTc-albumin colloid and Patent Blue V dye. SLNB was followed by standard axillary treatment at the same operation in all patients.
Sentinel lymph nodes (SLNs) were identified in 803 (96.1%) of 836 evaluable cases. The median number of SLNs removed per patient was 2 (range 1-9). There were 19 false negatives, resulting in a sensitivity of 263/282 (93.3%) and accuracy 782/803 (97.6%). SLNs were successfully identified by blue dye in 698 (85.6%), by isotope in 698 (85.6%), and by the combination of blue dye and isotope in 782 (96.0%) of 815 patients. Among 276 node positive patients, one or more positive SLNs were identified by blue dye in 251 (90.9%), by isotope in 246 (89.1%) and by the combination of blue dye and gamma probe in 258 (93.5%). Obesity, tumor location other than upper outer quadrant and non-visualisation of SLNs on the pre-operative lymphoscintiscan were significantly associated with failed localisation (p |
| doi_str_mv | 10.1007/s10549-006-9192-1 |
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Eight-hundred and fourty-two patients with clinically node-negative breast cancer underwent SLNB according to a standardised protocol that used a combination of radiopharmaceutical 99mTc-albumin colloid and Patent Blue V dye. SLNB was followed by standard axillary treatment at the same operation in all patients.
Sentinel lymph nodes (SLNs) were identified in 803 (96.1%) of 836 evaluable cases. The median number of SLNs removed per patient was 2 (range 1-9). There were 19 false negatives, resulting in a sensitivity of 263/282 (93.3%) and accuracy 782/803 (97.6%). SLNs were successfully identified by blue dye in 698 (85.6%), by isotope in 698 (85.6%), and by the combination of blue dye and isotope in 782 (96.0%) of 815 patients. Among 276 node positive patients, one or more positive SLNs were identified by blue dye in 251 (90.9%), by isotope in 246 (89.1%) and by the combination of blue dye and gamma probe in 258 (93.5%). Obesity, tumor location other than upper outer quadrant and non-visualisation of SLNs on the pre-operative lymphoscintiscan were significantly associated with failed localisation (p<0.001, p=0.008, p<0.001, respectively). The false-negative rate in patients with grade 3 tumors was 9.6%, compared with 4.7% in those with grade 2 tumors (p=0.022). The false-negative rate in patients who had one SLN harvested was 10.1%, compared with 1.1% in those who had multiple SLNs (three or more) removed (p=0.010).
SLNB can accurately determine whether axillary metastases are present in patients with early stage breast cancer with clinically negative axillary nodes. Both success and accuracy of SLNB are optimised by the combined use of blue dye and isotope. SLNB success decreases with increasing body mass, tumor location other than the upper outer quadrant and non-visualisation of hot nodes on the pre-operative lymphoscintiscan. This study demonstrates reduction in the predictive value of a negative SLNB in grade 3 tumors.</description><identifier>ISSN: 0167-6806</identifier><identifier>EISSN: 1573-7217</identifier><identifier>DOI: 10.1007/s10549-006-9192-1</identifier><identifier>PMID: 16541308</identifier><identifier>CODEN: BCTRD6</identifier><language>eng</language><publisher>Dordrecht: Springer</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Axilla ; Biological and medical sciences ; Biopsy ; Breast cancer ; Breast Neoplasms - diagnostic imaging ; Breast Neoplasms - pathology ; Breast Neoplasms - surgery ; Cancer research ; Cancer therapies ; Carcinoma, Ductal, Breast - secondary ; Carcinoma, Ductal, Breast - surgery ; Carcinoma, Lobular - secondary ; Carcinoma, Lobular - surgery ; Dyes ; False Negative Reactions ; Female ; Gynecology. Andrology. Obstetrics ; Humans ; Lymph Nodes - diagnostic imaging ; Lymph Nodes - pathology ; Lymphatic Metastasis ; Lymphatic system ; Mammary gland diseases ; Medical research ; Medical sciences ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local - pathology ; Neoplasm Staging ; Predictive Value of Tests ; Prospective Studies ; Radioisotopes ; Radionuclide Imaging ; Radiopharmaceuticals ; Risk Factors ; Rosaniline Dyes ; Sentinel Lymph Node Biopsy ; Technetium Tc 99m Aggregated Albumin ; Tumors</subject><ispartof>Breast cancer research and treatment, 2006-09, Vol.99 (2), p.203-208</ispartof><rights>2006 INIST-CNRS</rights><rights>Springer Science+Business Media, Inc. 2006</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c356t-cef64aae6b4135245208d51340173ce4932be483d9d956c1dd4c0b70fb7eca753</citedby><cites>FETCH-LOGICAL-c356t-cef64aae6b4135245208d51340173ce4932be483d9d956c1dd4c0b70fb7eca753</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18090439$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16541308$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>GOYAL, Amit</creatorcontrib><creatorcontrib>NEWCOMBE, Robert G</creatorcontrib><creatorcontrib>CHHABRA, Alok</creatorcontrib><creatorcontrib>MANSEL, Robert E</creatorcontrib><creatorcontrib>ALMANAC Trialists Group</creatorcontrib><creatorcontrib>on behalf of the ALMANAC Trialists Group</creatorcontrib><title>Factors affecting failed localisation and false-negative rates of sentinel node biopsy in breast cancer : results of the ALMANAC validation phase</title><title>Breast cancer research and treatment</title><addtitle>Breast Cancer Res Treat</addtitle><description>Despite the widespread application of sentinel lymph node biopsy (SLNB) for early stage breast cancer, there is a wide variation in reported test performance characteristics. A major aim of this prospective multicentre validation study was to quantify detection and false-negative rates of SLNB and evaluate factors influencing them.
Eight-hundred and fourty-two patients with clinically node-negative breast cancer underwent SLNB according to a standardised protocol that used a combination of radiopharmaceutical 99mTc-albumin colloid and Patent Blue V dye. SLNB was followed by standard axillary treatment at the same operation in all patients.
Sentinel lymph nodes (SLNs) were identified in 803 (96.1%) of 836 evaluable cases. The median number of SLNs removed per patient was 2 (range 1-9). There were 19 false negatives, resulting in a sensitivity of 263/282 (93.3%) and accuracy 782/803 (97.6%). SLNs were successfully identified by blue dye in 698 (85.6%), by isotope in 698 (85.6%), and by the combination of blue dye and isotope in 782 (96.0%) of 815 patients. Among 276 node positive patients, one or more positive SLNs were identified by blue dye in 251 (90.9%), by isotope in 246 (89.1%) and by the combination of blue dye and gamma probe in 258 (93.5%). Obesity, tumor location other than upper outer quadrant and non-visualisation of SLNs on the pre-operative lymphoscintiscan were significantly associated with failed localisation (p<0.001, p=0.008, p<0.001, respectively). The false-negative rate in patients with grade 3 tumors was 9.6%, compared with 4.7% in those with grade 2 tumors (p=0.022). The false-negative rate in patients who had one SLN harvested was 10.1%, compared with 1.1% in those who had multiple SLNs (three or more) removed (p=0.010).
SLNB can accurately determine whether axillary metastases are present in patients with early stage breast cancer with clinically negative axillary nodes. Both success and accuracy of SLNB are optimised by the combined use of blue dye and isotope. SLNB success decreases with increasing body mass, tumor location other than the upper outer quadrant and non-visualisation of hot nodes on the pre-operative lymphoscintiscan. This study demonstrates reduction in the predictive value of a negative SLNB in grade 3 tumors.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Axilla</subject><subject>Biological and medical sciences</subject><subject>Biopsy</subject><subject>Breast cancer</subject><subject>Breast Neoplasms - diagnostic imaging</subject><subject>Breast Neoplasms - pathology</subject><subject>Breast Neoplasms - surgery</subject><subject>Cancer research</subject><subject>Cancer therapies</subject><subject>Carcinoma, Ductal, Breast - secondary</subject><subject>Carcinoma, Ductal, Breast - surgery</subject><subject>Carcinoma, Lobular - secondary</subject><subject>Carcinoma, Lobular - surgery</subject><subject>Dyes</subject><subject>False Negative Reactions</subject><subject>Female</subject><subject>Gynecology. Andrology. Obstetrics</subject><subject>Humans</subject><subject>Lymph Nodes - diagnostic imaging</subject><subject>Lymph Nodes - pathology</subject><subject>Lymphatic Metastasis</subject><subject>Lymphatic system</subject><subject>Mammary gland diseases</subject><subject>Medical research</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Neoplasm Invasiveness</subject><subject>Neoplasm Recurrence, Local - pathology</subject><subject>Neoplasm Staging</subject><subject>Predictive Value of Tests</subject><subject>Prospective Studies</subject><subject>Radioisotopes</subject><subject>Radionuclide Imaging</subject><subject>Radiopharmaceuticals</subject><subject>Risk Factors</subject><subject>Rosaniline Dyes</subject><subject>Sentinel Lymph Node Biopsy</subject><subject>Technetium Tc 99m Aggregated Albumin</subject><subject>Tumors</subject><issn>0167-6806</issn><issn>1573-7217</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNpdkV1rFDEUhoModq3-AG8kCHo3ejL5mni3LFaFbb3R65BJzrRTZpM1mSn0Z_QfN9tdKHgVODzveZM8hLxn8IUB6K-FgRSmAVCNYaZt2AuyYlLzRrdMvyQrYEo3qgN1Rt6UcgsARoN5Tc6YkoJx6Fbk4cL5OeVC3TCgn8d4TQc3ThjolLybxuLmMUXqYqjzqWAT8bqO7pBmN2OhaaAFY83hRGMKSPsx7cs9HSPtM7oyU--ix0y_0YxlmeanyHyDdL29XF-tN_SutoRjy_7GFXxLXj01vTud5-Tvxfc_m5_N9vePX5v1tvFcqrnxOCjhHKq-vkS2QrbQBcm4AKa5R2F426PoeDDBSOVZCMJDr2HoNXqnJT8nn4979zn9W7DMdjcWj9PkIqalWNVpzaXpKvjxP_A2LTnWu9mWtUJL0R4gdoR8TqVkHOw-jzuX7y0De5Blj7JslWUPsiyrmQ-nxUu_w_CcONmpwKcT4EqVMeT6lWN55jowILjhj3LYnU0</recordid><startdate>20060901</startdate><enddate>20060901</enddate><creator>GOYAL, Amit</creator><creator>NEWCOMBE, Robert G</creator><creator>CHHABRA, Alok</creator><creator>MANSEL, Robert E</creator><general>Springer</general><general>Springer Nature B.V</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9-</scope><scope>K9.</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20060901</creationdate><title>Factors affecting failed localisation and false-negative rates of sentinel node biopsy in breast cancer : results of the ALMANAC validation phase</title><author>GOYAL, Amit ; NEWCOMBE, Robert G ; CHHABRA, Alok ; MANSEL, Robert E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c356t-cef64aae6b4135245208d51340173ce4932be483d9d956c1dd4c0b70fb7eca753</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Axilla</topic><topic>Biological and medical sciences</topic><topic>Biopsy</topic><topic>Breast cancer</topic><topic>Breast Neoplasms - diagnostic imaging</topic><topic>Breast Neoplasms - pathology</topic><topic>Breast Neoplasms - surgery</topic><topic>Cancer research</topic><topic>Cancer therapies</topic><topic>Carcinoma, Ductal, Breast - secondary</topic><topic>Carcinoma, Ductal, Breast - surgery</topic><topic>Carcinoma, Lobular - secondary</topic><topic>Carcinoma, Lobular - surgery</topic><topic>Dyes</topic><topic>False Negative Reactions</topic><topic>Female</topic><topic>Gynecology. Andrology. Obstetrics</topic><topic>Humans</topic><topic>Lymph Nodes - diagnostic imaging</topic><topic>Lymph Nodes - pathology</topic><topic>Lymphatic Metastasis</topic><topic>Lymphatic system</topic><topic>Mammary gland diseases</topic><topic>Medical research</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Neoplasm Invasiveness</topic><topic>Neoplasm Recurrence, Local - pathology</topic><topic>Neoplasm Staging</topic><topic>Predictive Value of Tests</topic><topic>Prospective Studies</topic><topic>Radioisotopes</topic><topic>Radionuclide Imaging</topic><topic>Radiopharmaceuticals</topic><topic>Risk Factors</topic><topic>Rosaniline Dyes</topic><topic>Sentinel Lymph Node Biopsy</topic><topic>Technetium Tc 99m Aggregated Albumin</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>GOYAL, Amit</creatorcontrib><creatorcontrib>NEWCOMBE, Robert G</creatorcontrib><creatorcontrib>CHHABRA, Alok</creatorcontrib><creatorcontrib>MANSEL, Robert E</creatorcontrib><creatorcontrib>ALMANAC Trialists Group</creatorcontrib><creatorcontrib>on behalf of the ALMANAC Trialists Group</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Breast cancer research and treatment</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>GOYAL, Amit</au><au>NEWCOMBE, Robert G</au><au>CHHABRA, Alok</au><au>MANSEL, Robert E</au><aucorp>ALMANAC Trialists Group</aucorp><aucorp>on behalf of the ALMANAC Trialists Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Factors affecting failed localisation and false-negative rates of sentinel node biopsy in breast cancer : results of the ALMANAC validation phase</atitle><jtitle>Breast cancer research and treatment</jtitle><addtitle>Breast Cancer Res Treat</addtitle><date>2006-09-01</date><risdate>2006</risdate><volume>99</volume><issue>2</issue><spage>203</spage><epage>208</epage><pages>203-208</pages><issn>0167-6806</issn><eissn>1573-7217</eissn><coden>BCTRD6</coden><abstract>Despite the widespread application of sentinel lymph node biopsy (SLNB) for early stage breast cancer, there is a wide variation in reported test performance characteristics. A major aim of this prospective multicentre validation study was to quantify detection and false-negative rates of SLNB and evaluate factors influencing them.
Eight-hundred and fourty-two patients with clinically node-negative breast cancer underwent SLNB according to a standardised protocol that used a combination of radiopharmaceutical 99mTc-albumin colloid and Patent Blue V dye. SLNB was followed by standard axillary treatment at the same operation in all patients.
Sentinel lymph nodes (SLNs) were identified in 803 (96.1%) of 836 evaluable cases. The median number of SLNs removed per patient was 2 (range 1-9). There were 19 false negatives, resulting in a sensitivity of 263/282 (93.3%) and accuracy 782/803 (97.6%). SLNs were successfully identified by blue dye in 698 (85.6%), by isotope in 698 (85.6%), and by the combination of blue dye and isotope in 782 (96.0%) of 815 patients. Among 276 node positive patients, one or more positive SLNs were identified by blue dye in 251 (90.9%), by isotope in 246 (89.1%) and by the combination of blue dye and gamma probe in 258 (93.5%). Obesity, tumor location other than upper outer quadrant and non-visualisation of SLNs on the pre-operative lymphoscintiscan were significantly associated with failed localisation (p<0.001, p=0.008, p<0.001, respectively). The false-negative rate in patients with grade 3 tumors was 9.6%, compared with 4.7% in those with grade 2 tumors (p=0.022). The false-negative rate in patients who had one SLN harvested was 10.1%, compared with 1.1% in those who had multiple SLNs (three or more) removed (p=0.010).
SLNB can accurately determine whether axillary metastases are present in patients with early stage breast cancer with clinically negative axillary nodes. Both success and accuracy of SLNB are optimised by the combined use of blue dye and isotope. SLNB success decreases with increasing body mass, tumor location other than the upper outer quadrant and non-visualisation of hot nodes on the pre-operative lymphoscintiscan. This study demonstrates reduction in the predictive value of a negative SLNB in grade 3 tumors.</abstract><cop>Dordrecht</cop><pub>Springer</pub><pmid>16541308</pmid><doi>10.1007/s10549-006-9192-1</doi><tpages>6</tpages></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Axilla Biological and medical sciences Biopsy Breast cancer Breast Neoplasms - diagnostic imaging Breast Neoplasms - pathology Breast Neoplasms - surgery Cancer research Cancer therapies Carcinoma, Ductal, Breast - secondary Carcinoma, Ductal, Breast - surgery Carcinoma, Lobular - secondary Carcinoma, Lobular - surgery Dyes False Negative Reactions Female Gynecology. Andrology. Obstetrics Humans Lymph Nodes - diagnostic imaging Lymph Nodes - pathology Lymphatic Metastasis Lymphatic system Mammary gland diseases Medical research Medical sciences Middle Aged Neoplasm Invasiveness Neoplasm Recurrence, Local - pathology Neoplasm Staging Predictive Value of Tests Prospective Studies Radioisotopes Radionuclide Imaging Radiopharmaceuticals Risk Factors Rosaniline Dyes Sentinel Lymph Node Biopsy Technetium Tc 99m Aggregated Albumin Tumors |
| title | Factors affecting failed localisation and false-negative rates of sentinel node biopsy in breast cancer : results of the ALMANAC validation phase |
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