Use of the dye-guided sentinel lymph node biopsy method alone for breast cancer metastasis to avoid unnecessary axillary lymph node dissection
Identifieur interne : 003E37 ( Pmc/Curation ); précédent : 003E36; suivant : 003E38Use of the dye-guided sentinel lymph node biopsy method alone for breast cancer metastasis to avoid unnecessary axillary lymph node dissection
Auteurs : Tomoko Takamaru [Japon] ; Goro Kutomi [Japon] ; Fukino Satomi [Japon] ; Hiroaki Shima [Japon] ; Keisuke Ohno [Japon] ; Hidekazu Kameshima [Japon] ; Yasuyo Suzuki [Japon] ; Tousei Ohmura [Japon] ; Hiroyuki Takamaru [Japon] ; Masanori Nojima [Japon] ; Mitsuru Mori [Japon] ; Koichi Hirata [Japon]Source :
- Experimental and Therapeutic Medicine [ 1792-0981 ] ; 2013.
Abstract
For sentinel lymph node biopsy (SLNB), a combination of dye-guided and γ-probe-guided methods is the most commonly used technique. However, the number of institutes in which the γ-probe-guided method is able to be performed is limited, since special equipment is required for the method. In this study, SLNB with the dye-guided method alone was evaluated, and the clinicopathological characteristics were analyzed to identify any factors that were predictive of whether the follow-up axillary lymph node dissection (ALND) was able to be omitted. A total of 374 patients who underwent SLNB between 1999 and 2009 were studied. The SLN identification rate was analyzed, in addition to the false-positive and false-negative rates and the correlation between the clinicopathological characteristics and axillary lymph node metastases. The SLN was identified in 96.8% of cases, and, out of the patients who had SLN metastasis, 63.0% did not exhibit metastasis elsewhere. The sensitivity was 96.4% and the specificity was 100%. The false-negative rate was 3.6%. Univariate analyses revealed significant differences in the lymph vessel invasion (ly) status, nuclear grade (NG), maximum tumor size and the percentage of the area occupied by the tumor cells in the SLN (SLN occupation ratio) between the patients with and without non-SLN metastasis, indicating that these factors may be predictive of axillary lymph node metastasis. Multivariate analysis revealed that ly status was an independent risk factor for non-SLN metastasis. In conclusion, SLN with the dye-guided method alone provided a high detection rate. The study identified a predictive factor for axillary lymph node metastasis that may improve the patients’ quality of life.
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DOI: 10.3892/etm.2013.1445
PubMed: 24396425
PubMed Central: 3881064
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060-8543</wicri:regionArea></affiliation></author><author><name sortKey="Takamaru, Hiroyuki" sort="Takamaru, Hiroyuki" uniqKey="Takamaru H" first="Hiroyuki" last="Takamaru">Hiroyuki Takamaru</name><affiliation wicri:level="1"><nlm:aff id="af2-etm-07-02-0456">First Department of Internal Medicine, Sapporo Medical University, Sapporo, Hokkaido 060-8543, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>First Department of Internal Medicine, Sapporo Medical University, Sapporo, Hokkaido 060-8543</wicri:regionArea></affiliation></author><author><name sortKey="Nojima, Masanori" sort="Nojima, Masanori" uniqKey="Nojima M" first="Masanori" last="Nojima">Masanori Nojima</name><affiliation wicri:level="1"><nlm:aff id="af3-etm-07-02-0456">Department of Public Health, Sapporo Medical University, Sapporo, Hokkaido 060-8556, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Public Health, Sapporo Medical University, Sapporo, Hokkaido 060-8556</wicri:regionArea></affiliation></author><author><name sortKey="Mori, Mitsuru" sort="Mori, Mitsuru" uniqKey="Mori M" first="Mitsuru" last="Mori">Mitsuru Mori</name><affiliation wicri:level="1"><nlm:aff id="af3-etm-07-02-0456">Department of Public Health, Sapporo Medical University, Sapporo, Hokkaido 060-8556, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Public Health, Sapporo Medical University, Sapporo, Hokkaido 060-8556</wicri:regionArea></affiliation></author><author><name sortKey="Hirata, Koichi" sort="Hirata, Koichi" uniqKey="Hirata K" first="Koichi" last="Hirata">Koichi Hirata</name><affiliation wicri:level="1"><nlm:aff id="af1-etm-07-02-0456">First Department of Surgery, Sapporo Medical University, Sapporo, Hokkaido 060-8543, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>First Department of Surgery, Sapporo Medical University, Sapporo, Hokkaido 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last="Takamaru">Tomoko Takamaru</name><affiliation wicri:level="1"><nlm:aff id="af1-etm-07-02-0456">First Department of Surgery, Sapporo Medical University, Sapporo, Hokkaido 060-8543, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>First Department of Surgery, Sapporo Medical University, Sapporo, Hokkaido 060-8543</wicri:regionArea></affiliation></author><author><name sortKey="Kutomi, Goro" sort="Kutomi, Goro" uniqKey="Kutomi G" first="Goro" last="Kutomi">Goro Kutomi</name><affiliation wicri:level="1"><nlm:aff id="af1-etm-07-02-0456">First Department of Surgery, Sapporo Medical University, Sapporo, Hokkaido 060-8543, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>First Department of Surgery, Sapporo Medical University, Sapporo, Hokkaido 060-8543</wicri:regionArea></affiliation></author><author><name sortKey="Satomi, Fukino" sort="Satomi, Fukino" uniqKey="Satomi F" first="Fukino" last="Satomi">Fukino Satomi</name><affiliation wicri:level="1"><nlm:aff id="af1-etm-07-02-0456">First Department of Surgery, Sapporo Medical University, Sapporo, Hokkaido 060-8543, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>First Department of Surgery, Sapporo Medical University, Sapporo, Hokkaido 060-8543</wicri:regionArea></affiliation></author><author><name sortKey="Shima, Hiroaki" sort="Shima, Hiroaki" uniqKey="Shima H" first="Hiroaki" last="Shima">Hiroaki Shima</name><affiliation wicri:level="1"><nlm:aff id="af1-etm-07-02-0456">First Department of Surgery, Sapporo Medical University, Sapporo, Hokkaido 060-8543, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>First Department of Surgery, Sapporo Medical University, Sapporo, Hokkaido 060-8543</wicri:regionArea></affiliation></author><author><name sortKey="Ohno, Keisuke" sort="Ohno, Keisuke" uniqKey="Ohno K" first="Keisuke" last="Ohno">Keisuke Ohno</name><affiliation wicri:level="1"><nlm:aff id="af1-etm-07-02-0456">First Department of Surgery, Sapporo Medical University, Sapporo, Hokkaido 060-8543, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>First Department of Surgery, Sapporo Medical University, Sapporo, Hokkaido 060-8543</wicri:regionArea></affiliation></author><author><name sortKey="Kameshima, Hidekazu" sort="Kameshima, Hidekazu" uniqKey="Kameshima H" first="Hidekazu" last="Kameshima">Hidekazu Kameshima</name><affiliation wicri:level="1"><nlm:aff id="af1-etm-07-02-0456">First Department of Surgery, Sapporo Medical University, Sapporo, Hokkaido 060-8543, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>First Department of Surgery, Sapporo Medical University, Sapporo, Hokkaido 060-8543</wicri:regionArea></affiliation></author><author><name sortKey="Suzuki, Yasuyo" sort="Suzuki, Yasuyo" uniqKey="Suzuki Y" first="Yasuyo" last="Suzuki">Yasuyo Suzuki</name><affiliation wicri:level="1"><nlm:aff id="af1-etm-07-02-0456">First Department of Surgery, Sapporo Medical University, Sapporo, Hokkaido 060-8543, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>First Department of Surgery, Sapporo Medical University, Sapporo, Hokkaido 060-8543</wicri:regionArea></affiliation></author><author><name sortKey="Ohmura, Tousei" sort="Ohmura, Tousei" uniqKey="Ohmura T" first="Tousei" last="Ohmura">Tousei Ohmura</name><affiliation wicri:level="1"><nlm:aff id="af1-etm-07-02-0456">First Department of Surgery, Sapporo Medical University, Sapporo, Hokkaido 060-8543, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>First Department of Surgery, Sapporo Medical University, Sapporo, Hokkaido 060-8543</wicri:regionArea></affiliation></author><author><name sortKey="Takamaru, Hiroyuki" sort="Takamaru, Hiroyuki" uniqKey="Takamaru H" first="Hiroyuki" last="Takamaru">Hiroyuki Takamaru</name><affiliation wicri:level="1"><nlm:aff id="af2-etm-07-02-0456">First Department of Internal Medicine, Sapporo Medical University, Sapporo, Hokkaido 060-8543, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>First Department of Internal Medicine, Sapporo Medical University, Sapporo, Hokkaido 060-8543</wicri:regionArea></affiliation></author><author><name sortKey="Nojima, Masanori" sort="Nojima, Masanori" uniqKey="Nojima M" first="Masanori" last="Nojima">Masanori Nojima</name><affiliation wicri:level="1"><nlm:aff id="af3-etm-07-02-0456">Department of Public Health, Sapporo Medical University, Sapporo, Hokkaido 060-8556, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Public Health, Sapporo Medical University, Sapporo, Hokkaido 060-8556</wicri:regionArea></affiliation></author><author><name sortKey="Mori, Mitsuru" sort="Mori, Mitsuru" uniqKey="Mori M" first="Mitsuru" last="Mori">Mitsuru Mori</name><affiliation wicri:level="1"><nlm:aff id="af3-etm-07-02-0456">Department of Public Health, Sapporo Medical University, Sapporo, Hokkaido 060-8556, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Public Health, Sapporo Medical University, Sapporo, Hokkaido 060-8556</wicri:regionArea></affiliation></author><author><name sortKey="Hirata, Koichi" sort="Hirata, Koichi" uniqKey="Hirata K" first="Koichi" last="Hirata">Koichi Hirata</name><affiliation wicri:level="1"><nlm:aff id="af1-etm-07-02-0456">First Department of Surgery, Sapporo Medical University, Sapporo, Hokkaido 060-8543, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>First Department of Surgery, Sapporo Medical University, Sapporo, Hokkaido 060-8543</wicri:regionArea></affiliation></author></analytic><series><title level="j">Experimental and Therapeutic Medicine</title><idno type="ISSN">1792-0981</idno><idno type="eISSN">1792-1015</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>For sentinel lymph node biopsy (SLNB), a combination of dye-guided and γ-probe-guided methods is the most commonly used technique. However, the number of institutes in which the γ-probe-guided method is able to be performed is limited, since special equipment is required for the method. In this study, SLNB with the dye-guided method alone was evaluated, and the clinicopathological characteristics were analyzed to identify any factors that were predictive of whether the follow-up axillary lymph node dissection (ALND) was able to be omitted. A total of 374 patients who underwent SLNB between 1999 and 2009 were studied. The SLN identification rate was analyzed, in addition to the false-positive and false-negative rates and the correlation between the clinicopathological characteristics and axillary lymph node metastases. The SLN was identified in 96.8% of cases, and, out of the patients who had SLN metastasis, 63.0% did not exhibit metastasis elsewhere. The sensitivity was 96.4% and the specificity was 100%. The false-negative rate was 3.6%. Univariate analyses revealed significant differences in the lymph vessel invasion (ly) status, nuclear grade (NG), maximum tumor size and the percentage of the area occupied by the tumor cells in the SLN (SLN occupation ratio) between the patients with and without non-SLN metastasis, indicating that these factors may be predictive of axillary lymph node metastasis. Multivariate analysis revealed that ly status was an independent risk factor for non-SLN metastasis. In conclusion, SLN with the dye-guided method alone provided a high detection rate. The study identified a predictive factor for axillary lymph node metastasis that may improve the patients’ quality of life.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Senofsky, Gm" uniqKey="Senofsky G">GM Senofsky</name></author><author><name sortKey="Moffat, Fl" uniqKey="Moffat F">FL Moffat</name></author><author><name sortKey="Davis, K" uniqKey="Davis K">K Davis</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fentiman, Is" uniqKey="Fentiman I">IS Fentiman</name></author><author><name sortKey="Mansel, Re" uniqKey="Mansel R">RE Mansel</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Noguchi, M" uniqKey="Noguchi M">M Noguchi</name></author><author><name sortKey="Miwa, K" uniqKey="Miwa K">K Miwa</name></author><author><name sortKey="Michigishi, T" uniqKey="Michigishi T">T Michigishi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kissin, Mw" uniqKey="Kissin M">MW Kissin</name></author><author><name sortKey="Querci Della Rovere, G" uniqKey="Querci Della Rovere G">G Querci della Rovere</name></author><author><name sortKey="Easton, D" uniqKey="Easton D">D Easton</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cox, C" uniqKey="Cox C">C Cox</name></author><author><name sortKey="White, L" uniqKey="White L">L White</name></author><author><name sortKey="Allred, N" uniqKey="Allred N">N Allred</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kuijt, Gp" uniqKey="Kuijt G">GP Kuijt</name></author><author><name sortKey="Van De Poll Franse, Lv" uniqKey="Van De Poll Franse L">LV van de Poll-Franse</name></author><author><name sortKey="Voogd, Ac" uniqKey="Voogd A">AC Voogd</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Langer, I" uniqKey="Langer I">I Langer</name></author><author><name sortKey="Guller, U" uniqKey="Guller U">U Guller</name></author><author><name sortKey="Hsu Schmitz, Sf" uniqKey="Hsu Schmitz S">SF Hsu-Schmitz</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Van Der Ploeg, Im" uniqKey="Van Der Ploeg I">IM van der Ploeg</name></author><author><name sortKey="Nieweg, Oe" uniqKey="Nieweg O">OE Nieweg</name></author><author><name sortKey="Van Rijk, Mc" uniqKey="Van Rijk M">MC van Rijk</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lucci, A" uniqKey="Lucci A">A Lucci</name></author><author><name sortKey="Mccall, Lm" uniqKey="Mccall L">LM McCall</name></author><author><name sortKey="Beitsch, Pd" uniqKey="Beitsch P">PD Beitsch</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Celebioglu, F" uniqKey="Celebioglu F">F Celebioglu</name></author><author><name sortKey="Perbeck, L" uniqKey="Perbeck L">L Perbeck</name></author><author><name sortKey="Frisell, J" uniqKey="Frisell J">J Frisell</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cox, Ce" uniqKey="Cox C">CE Cox</name></author><author><name sortKey="Bass, Ss" uniqKey="Bass S">SS Bass</name></author><author><name sortKey="Mccann, Cr" uniqKey="Mccann C">CR McCann</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kim, T" uniqKey="Kim T">T Kim</name></author><author><name sortKey="Giuliano, Ae" uniqKey="Giuliano A">AE Giuliano</name></author><author><name sortKey="Lyman, Gh" uniqKey="Lyman G">GH Lyman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Morrow, M" uniqKey="Morrow M">M Morrow</name></author><author><name sortKey="Rademaker, Aw" uniqKey="Rademaker A">AW Rademaker</name></author><author><name sortKey="Bethke, Kp" uniqKey="Bethke K">KP Bethke</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Exp Ther Med</journal-id><journal-id journal-id-type="iso-abbrev">Exp Ther Med</journal-id><journal-id journal-id-type="publisher-id">ETM</journal-id><journal-title-group><journal-title>Experimental and Therapeutic Medicine</journal-title></journal-title-group><issn pub-type="ppub">1792-0981</issn><issn pub-type="epub">1792-1015</issn><publisher><publisher-name>D.A. Spandidos</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24396425</article-id><article-id pub-id-type="pmc">3881064</article-id><article-id pub-id-type="doi">10.3892/etm.2013.1445</article-id><article-id pub-id-type="publisher-id">etm-07-02-0456</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group></article-categories><title-group><article-title>Use of the dye-guided sentinel lymph node biopsy method alone for breast cancer metastasis to avoid unnecessary axillary lymph node dissection</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>TAKAMARU</surname><given-names>TOMOKO</given-names></name><xref ref-type="aff" rid="af1-etm-07-02-0456">1</xref></contrib><contrib contrib-type="author"><name><surname>KUTOMI</surname><given-names>GORO</given-names></name><xref ref-type="aff" rid="af1-etm-07-02-0456">1</xref></contrib><contrib contrib-type="author"><name><surname>SATOMI</surname><given-names>FUKINO</given-names></name><xref ref-type="aff" rid="af1-etm-07-02-0456">1</xref></contrib><contrib contrib-type="author"><name><surname>SHIMA</surname><given-names>HIROAKI</given-names></name><xref ref-type="aff" rid="af1-etm-07-02-0456">1</xref></contrib><contrib contrib-type="author"><name><surname>OHNO</surname><given-names>KEISUKE</given-names></name><xref ref-type="aff" rid="af1-etm-07-02-0456">1</xref></contrib><contrib contrib-type="author"><name><surname>KAMESHIMA</surname><given-names>HIDEKAZU</given-names></name><xref ref-type="aff" rid="af1-etm-07-02-0456">1</xref></contrib><contrib contrib-type="author"><name><surname>SUZUKI</surname><given-names>YASUYO</given-names></name><xref ref-type="aff" rid="af1-etm-07-02-0456">1</xref></contrib><contrib contrib-type="author"><name><surname>OHMURA</surname><given-names>TOUSEI</given-names></name><xref ref-type="aff" rid="af1-etm-07-02-0456">1</xref></contrib><contrib contrib-type="author"><name><surname>TAKAMARU</surname><given-names>HIROYUKI</given-names></name><xref ref-type="aff" rid="af2-etm-07-02-0456">2</xref></contrib><contrib contrib-type="author"><name><surname>NOJIMA</surname><given-names>MASANORI</given-names></name><xref ref-type="aff" rid="af3-etm-07-02-0456">3</xref></contrib><contrib contrib-type="author"><name><surname>MORI</surname><given-names>MITSURU</given-names></name><xref ref-type="aff" rid="af3-etm-07-02-0456">3</xref></contrib><contrib contrib-type="author"><name><surname>HIRATA</surname><given-names>KOICHI</given-names></name><xref ref-type="aff" rid="af1-etm-07-02-0456">1</xref><xref ref-type="corresp" rid="c1-etm-07-02-0456"></xref></contrib></contrib-group><aff id="af1-etm-07-02-0456"><label>1</label>First Department of Surgery, Sapporo Medical University, Sapporo, Hokkaido 060-8543, Japan</aff><aff id="af2-etm-07-02-0456"><label>2</label>First Department of Internal Medicine, Sapporo Medical University, Sapporo, Hokkaido 060-8543, Japan</aff><aff id="af3-etm-07-02-0456"><label>3</label>Department of Public Health, Sapporo Medical University, Sapporo, Hokkaido 060-8556, Japan</aff><author-notes><corresp id="c1-etm-07-02-0456">Correspondence to: Professor Koichi Hirata, First Department of Surgery, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan, E-mail: <email>fujikane@sapmed.ac.jp</email></corresp></author-notes><pub-date pub-type="ppub"><month>2</month><year>2014</year></pub-date><pub-date pub-type="epub"><day>11</day><month>12</month><year>2013</year></pub-date><pub-date pub-type="pmc-release"><day>11</day><month>12</month><year>2013</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on the
<volume>7</volume><issue>2</issue><fpage>456</fpage><lpage>460</lpage><history><date date-type="received"><day>19</day><month>6</month><year>2013</year></date><date date-type="accepted"><day>21</day><month>10</month><year>2013</year></date></history><permissions><copyright-statement>Copyright © 2014, Spandidos Publications</copyright-statement><copyright-year>2014</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/3.0"><license-p>This is an open-access article licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License. The article may be redistributed, reproduced, and reused for non-commercial purposes, provided the original source is properly cited.</license-p></license></permissions><abstract><p>For sentinel lymph node biopsy (SLNB), a combination of dye-guided and γ-probe-guided methods is the most commonly used technique. However, the number of institutes in which the γ-probe-guided method is able to be performed is limited, since special equipment is required for the method. In this study, SLNB with the dye-guided method alone was evaluated, and the clinicopathological characteristics were analyzed to identify any factors that were predictive of whether the follow-up axillary lymph node dissection (ALND) was able to be omitted. A total of 374 patients who underwent SLNB between 1999 and 2009 were studied. The SLN identification rate was analyzed, in addition to the false-positive and false-negative rates and the correlation between the clinicopathological characteristics and axillary lymph node metastases. The SLN was identified in 96.8% of cases, and, out of the patients who had SLN metastasis, 63.0% did not exhibit metastasis elsewhere. The sensitivity was 96.4% and the specificity was 100%. The false-negative rate was 3.6%. Univariate analyses revealed significant differences in the lymph vessel invasion (ly) status, nuclear grade (NG), maximum tumor size and the percentage of the area occupied by the tumor cells in the SLN (SLN occupation ratio) between the patients with and without non-SLN metastasis, indicating that these factors may be predictive of axillary lymph node metastasis. Multivariate analysis revealed that ly status was an independent risk factor for non-SLN metastasis. In conclusion, SLN with the dye-guided method alone provided a high detection rate. The study identified a predictive factor for axillary lymph node metastasis that may improve the patients’ quality of life.</p></abstract><kwd-group><kwd>axillary lymph node dissection</kwd><kwd>breast cancer</kwd><kwd>dye-guided method</kwd><kwd>sentinel lymph node biopsy</kwd><kwd>prediction of lymph node metastasis</kwd></kwd-group></article-meta></front><floats-group><fig id="f1-etm-07-02-0456" orientation="portrait" position="float"><label>Figure 1</label><caption><p>Patient status. SLNB, sentinel lymph node biopsy; SLN, sentinel lymph node; ALND, axillary lymph node dissection.</p></caption><graphic xlink:href="ETM-07-02-0456-g00"></graphic></fig><table-wrap id="tI-etm-07-02-0456" orientation="portrait" position="float"><label>Table I</label><caption><p>Characteristics of 374 patients who underwent SLNB.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" valign="bottom" rowspan="1" colspan="1">Clinical features</th><th align="center" valign="bottom" rowspan="1" colspan="1">No. of patients (%)</th></tr></thead><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">Mean age, years (range)</td><td align="center" valign="top" rowspan="1" colspan="1">56.7 (23–87)</td></tr><tr><td colspan="2" align="left" valign="top" rowspan="1">Location of tumor</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Medial</td><td align="center" valign="top" rowspan="1" colspan="1">103 (27.5)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Lateral</td><td align="center" valign="top" rowspan="1" colspan="1">264 (70.6)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Central</td><td align="center" valign="top" rowspan="1" colspan="1">7 (1.9)</td></tr><tr><td colspan="2" align="left" valign="top" rowspan="1">Clinical tumor stage</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> T0</td><td align="center" valign="top" rowspan="1" colspan="1">14 (3.7)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> T1</td><td align="center" valign="top" rowspan="1" colspan="1">175 (46.8)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> T2</td><td align="center" valign="top" rowspan="1" colspan="1">161 (43.0)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> T3</td><td align="center" valign="top" rowspan="1" colspan="1">19 (5.1)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> T4</td><td align="center" valign="top" rowspan="1" colspan="1">5 (1.3)</td></tr><tr><td colspan="2" align="left" valign="top" rowspan="1">Clinical nodal stage</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> N0</td><td align="center" valign="top" rowspan="1" colspan="1">332 (88.8)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> N1</td><td align="center" valign="top" rowspan="1" colspan="1">41 (11.0)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> N2</td><td align="center" valign="top" rowspan="1" colspan="1">1 (0.3)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> N3</td><td align="center" valign="top" rowspan="1" colspan="1">0 (0.0)</td></tr><tr><td colspan="2" align="left" valign="top" rowspan="1">No. of SLN</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 1</td><td align="center" valign="top" rowspan="1" colspan="1">149 (39.8)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 2</td><td align="center" valign="top" rowspan="1" colspan="1">130 (34.8)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 3</td><td align="center" valign="top" rowspan="1" colspan="1">56 (15.0)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 4</td><td align="center" valign="top" rowspan="1" colspan="1">18 (4.8)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> ≥5</td><td align="center" valign="top" rowspan="1" colspan="1">9 (2.4)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Not detected</td><td align="center" valign="top" rowspan="1" colspan="1">12 (3.2)</td></tr></tbody></table><table-wrap-foot><fn id="tfn1-etm-07-02-0456"><p>SLNB, sentinel lymph node biopsy.</p></fn></table-wrap-foot></table-wrap><table-wrap id="tII-etm-07-02-0456" orientation="portrait" position="float"><label>Table II</label><caption><p>Diagnosis of sentinel lymph node metastases.</p></caption><table frame="hsides" rules="groups"><thead><tr><th colspan="4" align="left" valign="bottom" rowspan="1">A. Postoperative diagnosis</th></tr><tr><th colspan="4" align="left" valign="bottom" rowspan="1"><hr></hr></th></tr><tr><th align="left" valign="bottom" rowspan="1" colspan="1">Postoperative diagnosis</th><th align="center" valign="bottom" rowspan="1" colspan="1">SLN or non-SLN-positive</th><th align="center" valign="bottom" rowspan="1" colspan="1">SLN and non-SLN-negative</th><th align="center" valign="bottom" rowspan="1" colspan="1">Total</th></tr></thead><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">SLN-positive</td><td align="center" valign="top" rowspan="1" colspan="1">54</td><td align="center" valign="top" rowspan="1" colspan="1">0</td><td align="right" valign="top" rowspan="1" colspan="1">54</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">SLN-negative</td><td align="center" valign="top" rowspan="1" colspan="1">2</td><td align="center" valign="top" rowspan="1" colspan="1">47</td><td align="right" valign="top" rowspan="1" colspan="1">49</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Total</td><td align="center" valign="top" rowspan="1" colspan="1">56</td><td align="center" valign="top" rowspan="1" colspan="1">47</td><td align="right" valign="top" rowspan="1" colspan="1">103</td></tr><tr><td colspan="4" align="left" valign="top" rowspan="1"><hr></hr></td></tr><tr><td colspan="4" align="left" valign="top" rowspan="1">B. Intraoperative diagnosis</td></tr><tr><td colspan="4" align="left" valign="top" rowspan="1"><hr></hr></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Intraoperative diagnosis</td><td align="center" valign="top" rowspan="1" colspan="1">SLN-positive</td><td align="center" valign="top" rowspan="1" colspan="1">SLN-negative</td><td align="right" valign="top" rowspan="1" colspan="1">Total</td></tr><tr><td colspan="4" align="left" valign="top" rowspan="1"><hr></hr></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">SLN-positive</td><td align="center" valign="top" rowspan="1" colspan="1">54</td><td align="center" valign="top" rowspan="1" colspan="1">0</td><td align="right" valign="top" rowspan="1" colspan="1">54</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">SLN-negative</td><td align="center" valign="top" rowspan="1" colspan="1">8</td><td align="center" valign="top" rowspan="1" colspan="1">300</td><td align="right" valign="top" rowspan="1" colspan="1">308</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Total</td><td align="center" valign="top" rowspan="1" colspan="1">62</td><td align="center" valign="top" rowspan="1" colspan="1">300</td><td align="right" valign="top" rowspan="1" colspan="1">362</td></tr></tbody></table><table-wrap-foot><fn id="tfn2-etm-07-02-0456"><p>Postoperative diagnosis: The sensitivity for sentinel lymph node (SLN) metastasis was 96.4%, the specificity was 100% and the false-negative rate was 3.6%. Intraoperative diagnosis: A diagnostic accuracy of 97.8%, a sensitivity of 87.1% and specificity of 100% were achieved with hematoxylin and eosin (H&E) staining in the frozen sections; the false-negative rate was 12.9%.</p></fn></table-wrap-foot></table-wrap><table-wrap id="tIII-etm-07-02-0456" orientation="portrait" position="float"><label>Table III</label><caption><p>Clinicopathological factors correlated with non-SLN metastasis.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" valign="bottom" rowspan="1" colspan="1">Clinical feature</th><th align="center" valign="bottom" rowspan="1" colspan="1">SLN only</th><th align="center" valign="bottom" rowspan="1" colspan="1">SLN and non-SLN</th><th align="center" valign="bottom" rowspan="1" colspan="1">P-value</th></tr></thead><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">Mean age (years)</td><td align="center" valign="top" rowspan="1" colspan="1">59.76</td><td align="center" valign="top" rowspan="1" colspan="1">59.85</td><td align="center" valign="top" rowspan="1" colspan="1">0.9820</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Tumor size (cm)</td><td align="center" valign="top" rowspan="1" colspan="1">2.34</td><td align="center" valign="top" rowspan="1" colspan="1">2.92</td><td align="center" valign="top" rowspan="1" colspan="1">0.0317<xref rid="tfn4-etm-07-02-0456" ref-type="table-fn">a</xref></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">ly</td><td align="center" valign="top" rowspan="1" colspan="1"></td><td align="center" valign="top" rowspan="1" colspan="1"></td><td align="center" valign="top" rowspan="1" colspan="1">0.0002<xref rid="tfn5-etm-07-02-0456" ref-type="table-fn">b</xref></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> ly0</td><td align="center" valign="top" rowspan="1" colspan="1">12</td><td align="center" valign="top" rowspan="1" colspan="1">0</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> ly1–3</td><td align="center" valign="top" rowspan="1" colspan="1">20</td><td align="center" valign="top" rowspan="1" colspan="1">20</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">v</td><td align="center" valign="top" rowspan="1" colspan="1"></td><td align="center" valign="top" rowspan="1" colspan="1"></td><td align="center" valign="top" rowspan="1" colspan="1">0.2346</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> v0</td><td align="center" valign="top" rowspan="1" colspan="1">29</td><td align="center" valign="top" rowspan="1" colspan="1">15</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> v1</td><td align="center" valign="top" rowspan="1" colspan="1">3</td><td align="center" valign="top" rowspan="1" colspan="1">5</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">NG</td><td align="center" valign="top" rowspan="1" colspan="1"></td><td align="center" valign="top" rowspan="1" colspan="1"></td><td align="center" valign="top" rowspan="1" colspan="1">0.0433<xref rid="tfn4-etm-07-02-0456" ref-type="table-fn">a</xref></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 1</td><td align="center" valign="top" rowspan="1" colspan="1">20</td><td align="center" valign="top" rowspan="1" colspan="1">6</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 2–3</td><td align="center" valign="top" rowspan="1" colspan="1">11</td><td align="center" valign="top" rowspan="1" colspan="1">12</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Unknown</td><td align="center" valign="top" rowspan="1" colspan="1">3</td><td align="center" valign="top" rowspan="1" colspan="1">2</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">ER status</td><td align="center" valign="top" rowspan="1" colspan="1"></td><td align="center" valign="top" rowspan="1" colspan="1"></td><td align="center" valign="top" rowspan="1" colspan="1">0.7208</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Negative</td><td align="center" valign="top" rowspan="1" colspan="1">7</td><td align="center" valign="top" rowspan="1" colspan="1">3</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Positive</td><td align="center" valign="top" rowspan="1" colspan="1">24</td><td align="center" valign="top" rowspan="1" colspan="1">17</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Unknown</td><td align="center" valign="top" rowspan="1" colspan="1">3</td><td align="center" valign="top" rowspan="1" colspan="1">0</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td colspan="4" align="left" valign="top" rowspan="1">PgR status</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Negative</td><td align="center" valign="top" rowspan="1" colspan="1">10</td><td align="center" valign="top" rowspan="1" colspan="1">2</td><td align="center" valign="top" rowspan="1" colspan="1">0.0949</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Positive</td><td align="center" valign="top" rowspan="1" colspan="1">21</td><td align="center" valign="top" rowspan="1" colspan="1">18</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Unknown</td><td align="center" valign="top" rowspan="1" colspan="1">3</td><td align="center" valign="top" rowspan="1" colspan="1">0</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">HER2 status</td><td align="center" valign="top" rowspan="1" colspan="1"></td><td align="center" valign="top" rowspan="1" colspan="1"></td><td align="center" valign="top" rowspan="1" colspan="1">0.6958</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Negative</td><td align="center" valign="top" rowspan="1" colspan="1">27</td><td align="center" valign="top" rowspan="1" colspan="1">16</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Positive</td><td align="center" valign="top" rowspan="1" colspan="1">4</td><td align="center" valign="top" rowspan="1" colspan="1">4</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Unknown</td><td align="center" valign="top" rowspan="1" colspan="1">3</td><td align="center" valign="top" rowspan="1" colspan="1">0</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">SLN occupation ratio (%)</td><td align="center" valign="top" rowspan="1" colspan="1">21.47</td><td align="center" valign="top" rowspan="1" colspan="1">46.75</td><td align="center" valign="top" rowspan="1" colspan="1">0.0017<xref rid="tfn5-etm-07-02-0456" ref-type="table-fn">b</xref></td></tr></tbody></table><table-wrap-foot><fn id="tfn3-etm-07-02-0456"><p>P-values were calculated using either the t-test or the χ<sup>2</sup> test.</p></fn><fn id="tfn4-etm-07-02-0456"><label>a</label><p>P<0.05,</p></fn><fn id="tfn5-etm-07-02-0456"><label>b</label><p>P<0.01.</p></fn><fn id="tfn6-etm-07-02-0456"><p>SLN, sentinal lymph node; ly, lymph vessel invasion; v, vessel invasion; NG, nuclear grade; ER, estrogen receptor; PgR, progesterone receptor; HER2, human epidermal growth factor type 2; SLN occupation ratio, percentage of SLN area occupied by tumor cells.</p></fn></table-wrap-foot></table-wrap><table-wrap id="tIV-etm-07-02-0456" orientation="portrait" position="float"><label>Table IV</label><caption><p>Multivariate analysis.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" valign="bottom" rowspan="1" colspan="1">Risk factor for SLN metastasis</th><th align="center" valign="bottom" rowspan="1" colspan="1">P-value</th><th align="center" valign="bottom" rowspan="1" colspan="1">Relative risk</th><th align="center" valign="bottom" rowspan="1" colspan="1">95% CI</th></tr></thead><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">Age</td><td align="center" valign="top" rowspan="1" colspan="1">0.0938</td><td align="center" valign="top" rowspan="1" colspan="1">1.00</td><td align="center" valign="top" rowspan="1" colspan="1">0.93–1.07</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Maximum tumor size</td><td align="center" valign="top" rowspan="1" colspan="1">0.1477</td><td align="center" valign="top" rowspan="1" colspan="1">2.09</td><td align="center" valign="top" rowspan="1" colspan="1">0.81–8.24</td></tr><tr><td colspan="4" align="left" valign="top" rowspan="1">ly</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> ly0</td><td align="center" valign="top" rowspan="1" colspan="1">0.0138<xref rid="tfn7-etm-07-02-0456" ref-type="table-fn">a</xref></td><td align="center" valign="top" rowspan="1" colspan="1">1.00</td><td align="center" valign="top" rowspan="1" colspan="1">1.95–5.14×10<sup>19</sup></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> ly1–3</td><td align="center" valign="top" rowspan="1" colspan="1"></td><td align="center" valign="top" rowspan="1" colspan="1">7.08×10<sup>8</sup></td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td colspan="4" align="left" valign="top" rowspan="1">v</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> v0</td><td align="center" valign="top" rowspan="1" colspan="1">0.4950</td><td align="center" valign="top" rowspan="1" colspan="1">1.00</td><td align="center" valign="top" rowspan="1" colspan="1">0.27–20.47</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> v1</td><td align="center" valign="top" rowspan="1" colspan="1"></td><td align="center" valign="top" rowspan="1" colspan="1">2.03</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td colspan="4" align="left" valign="top" rowspan="1">NG</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 1</td><td align="center" valign="top" rowspan="1" colspan="1">0.1258</td><td align="center" valign="top" rowspan="1" colspan="1">1.00</td><td align="center" valign="top" rowspan="1" colspan="1">0.68–29.32</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 2–3</td><td align="center" valign="top" rowspan="1" colspan="1"></td><td align="center" valign="top" rowspan="1" colspan="1">4.05</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td colspan="4" align="left" valign="top" rowspan="1">ER status</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Negative</td><td align="center" valign="top" rowspan="1" colspan="1">0.8965</td><td align="center" valign="top" rowspan="1" colspan="1">1.00</td><td align="center" valign="top" rowspan="1" colspan="1">0.105–12.33</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Positive</td><td align="center" valign="top" rowspan="1" colspan="1"></td><td align="center" valign="top" rowspan="1" colspan="1">1.16</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td colspan="4" align="left" valign="top" rowspan="1">PgR status</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Negative</td><td align="center" valign="top" rowspan="1" colspan="1">0.0823</td><td align="center" valign="top" rowspan="1" colspan="1">1.00</td><td align="center" valign="top" rowspan="1" colspan="1">0.791–145.56</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Positive</td><td align="center" valign="top" rowspan="1" colspan="1"></td><td align="center" valign="top" rowspan="1" colspan="1">7.30</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td colspan="4" align="left" valign="top" rowspan="1">HER2 status</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Negative</td><td align="center" valign="top" rowspan="1" colspan="1">0.2760</td><td align="center" valign="top" rowspan="1" colspan="1">1.00</td><td align="center" valign="top" rowspan="1" colspan="1">0.43–25.07</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Positive</td><td align="center" valign="top" rowspan="1" colspan="1"></td><td align="center" valign="top" rowspan="1" colspan="1">3.00</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr></tbody></table><table-wrap-foot><fn id="tfn7-etm-07-02-0456"><label>a</label><p>P<0.05.</p></fn><fn id="tfn8-etm-07-02-0456"><p>SLN, sentinel lymph node; CI, confidence interval; ly, lymph vessel invasion; v, vessel invasion; NG, nuclear grade; ER, estrogen receptor; PgR, progesteron receptor; HER2, human epidermal growth factor type 2.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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