Frequency and Predictive Factors of Lymph Node Metastasis in T3 Breast Cancer: Implications for Sentinel Lymph Node Biopsy

Introduction: Breast cancer is one of the most common malignancies worldwide, with tumor size and axillary lymph node metastasis serving as crucial determinants for staging and prognosis. While sentinel lymph node biopsy (SLNB) is well-established for T1 and T2 breast lesions, its role in T3 breast cancer is controversial. This study evaluates the potential of SLNB as an alternative to axillary dissection for staging T3 breast cancer and explores the correlation between axillary metastasis and poor prognostic factors.

Materials and Methods: This prospective cross-sectional study was conducted at the Department of Breast Surgery, Liaquat National Hospital, Karachi, from January 2023 to March 2024. A total of 180 female patients with T3 breast lesions were assessed. Axillary lymph node status was evaluated clinically and radiologically, with suspicious nodes confirmed via histopathology. SLNB was performed on all patients undergoing surgery after neoadjuvant chemotherapy and on those with upfront surgery if their initial biopsy showed no axillary involvement.

Results: Of the 180 patients analyzed, 144 had clinically or radiologically suspicious axillary lymph nodes, and 104 were confirmed to have axillary metastasis through FNAC or trucut biopsy. Neoadjuvant chemotherapy was administered to 134 patients, while 46 underwent upfront surgery. In total, 82 patients (44.5%) required axillary clearance. Axillary clearance was associated with poor prognostic factors: 13 out of 39 HER2-positive patients, 10 out of 39 triple-negative patients, and 10 out of 51 patients with grade III tumors underwent the procedure.

Discussion: The findings indicate a notable reduction in axillary clearance rates among T3 breast cancer patients using SLNB, which reduces surgical morbidity. Only 44.5% of patients required axillary clearance, highlighting the efficacy of SLNB in staging while improving quality of life.

Conclusion: Sentinel lymph node biopsy is a reliable and less invasive approach for axillary staging in selected T3 breast cancer patients, particularly when neoadjuvant chemotherapy is used. This method has the potential to minimize unnecessary axillary dissection and associated complications.