Nine years of experience with the sentinel lymph node biopsy in a single Italian center: a retrospective analysis of 1,050 cases

Abstract

Background: This study aims to determine the prevalence and predictive factors for recurrence after sentinel lymph node biopsy (SLNB) and for sentinel lymph node positivity by SLNB in our population.

Methods: We followed up all SLNBs performed between 2002 and 2010 and analyzed data by R (version2.10.1), considering p < 0.05 significant.

Results: Among 1,050 patients with SLNB, 23% (245/1050) underwent secondary axillary dissection (CALND). Axillary recurrence prevalence among patients with negative SLNB was 1% (6/805) at a mean follow-up of 54 months (±14), and 1.7% (95% CI 0.2-3.1%) after 6 years of follow-up, as all recurrences developed between the 3rd and the 6th years of follow-up. By multivariate analysis, axillary recurrence results correlated with large tumor size, high number of excised nodes, lymphovascular invasion, high grading, multifocality, Her-2 positivity, intraductal histology, and comedo-like necrosis. Moreover, SLNB positivity results correlated with young age, large tumor size, high number of excised nodes, negative history for second primary malignancies, lymphovascular invasion, and high grading.

Conclusions: Cancer characteristics represent important predictive factors for SLNB positivity, as well as for axillary recurrence in patients with negative SLNB, independently, by surgical and nonsurgical treatment. Therefore, cancer biological behavior and the patient's hormonal profile should be evaluated with care to better tailor the follow-up of women with breast cancer.