Journal of the National Cancer Institute Advance Access published online on November 11, 2008
JNCI Journal of the National Cancer Institute, doi:10.1093/jnci/djn343
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© The Author 2008. Published by Oxford University Press.
REVIEW |
Non–Sentinel Lymph Node Metastases Associated With Isolated Breast Cancer Cells in the Sentinel Node
Affiliations of authors: Department of Pathology (CHMvD, PJvD), Julius Center for Health Sciences and Primary Care (EMM), and Department of Internal Medicine (EvdW), University Medical Center Utrecht, The Netherlands; Department of Internal Medicine, Division of Medical Oncology, Maastricht University Medical Center, Maastricht, The Netherlands (MdB, VCGT-H); Comprehensive Cancer Centre East, Nijmegen, The Netherlands (MdB); Department of Pathology, Radboud University Nijmegen Medical Center, The Netherlands (PB)
Correspondence to: Carolien H. M. van Deurzen, MD, Department of Pathology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands (e-mail: c.vandeurzen{at}umcutrecht.nl).
There are many reports on the frequency of non–sentinel lymph node involvement when isolated tumor cells are found in the sentinel node, but results and recommendations for the use of an axillary lymph node dissection differ among studies. This systematic review was conducted to give an overview of this issue and to provide recommendations for the use of an axillary lymph node dissection in these patients. We searched Medline, Embase, and Cochrane databases from January 1, 2002, through November 27, 2007, for articles on patients with invasive breast cancer who had isolated tumor cells in the sentinel lymph node (according to the sixth edition of the Cancer Staging Manual of the American Joint Committee on Cancer) and who also underwent axillary lymph node dissection. Of 411 selected articles, 29 (including 836 patients) were included in this review. These 29 studies were heterogeneous, reporting a wide range of non–sentinel lymph node involvement (defined as the presence of isolated tumor cells or micro- or macrometastases) associated with isolated tumor cells in the sentinel lymph node, with an overall pooled risk for such involvement of 12.3% (95% confidence interval = 9.5% to 15.7%). This pooled risk estimate was marginally higher than the risk of a false-negative sentinel lymph node biopsy examination (ie, 7%–8%) but marginally lower than the risk of non–sentinel lymph node metastases in patients with micrometastases (ie, approximately 20%) who are currently eligible for an axillary lymph node dissection. Because 36 (64%) of the 56 patients with isolated tumor cells in their sentinel lymph node also had non–sentinel lymph node macrometastases, those patients with isolated tumor cells in the sentinel lymph node without other indications for adjuvant systemic therapy might be candidates for axillary lymph node dissection.
The sponsor had no role in the design of the study, the collection of the data, the analysis and interpretation of the data, the decision to submit the manuscript for publication, or the writing of the manuscript. The authors thank Dr A. N. Milne for critical reading of the manuscript.
Manuscript received February 21, 2008; revised August 20, 2008; accepted August 25, 2008.
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J Natl Cancer Inst 2008 100: 1561.