Predictive Factors for Metastatic Involvement of Nonsentinel Nodes in Patients With Breast Cancer

Abstract

MOST PATIENTS who are eligible for a curative resection of breast cancer will not have axillary lymph node metastases. The sentinel node (SN) biopsy can now accurately identify this group of patients^1-4 and an axillary lymph node dissection (ALND) can be limited to patients with a positive SN. Moreover, the SN biopsy has the potential of becoming a routine procedure in centers with surgeons who have acquired adequate experience.^5-7 Several studies have shown that the SN seems to be the only positive axillary node in more than 50% of patients who have undergone a completion ALND.^1,3,5,6,8 It has been suggested that primary tumor size and SN tumor load both correlate with the incidence of additional metastases in the remaining axillary lymph nodes.^9,10 The chances of finding non-SN metastases are particularly low in patients with micrometastases in the SN, and the question is whether all patients with breast cancer with a positive SN will actually require an ALND.