Sentinel Lymph Node Biopsy in Breast Carcinoma: A Tertiary Center Experience

Objectives: To evaluate feasibility, accuracy and technique of sentinel lymph node biopsy in the management of early breast cancer.

Methods: A retrospective study of sentinel lymph node biopsy was done at King Abdulaziz University Hospital from June 2007– to –June 2013. Total of 110 patients were studied, these patients underwent lumpectomy + Sentinel lymph node biopsy. Patients records were studied by looking file, electronic records, OPD records and data was collected regarding previous surgery, location of mass in breast, size of mass, site of breast, pre or postmenopausal, previous axillary surgery, radiological evaluation, radiotherapy, type of surgery done, adjuvant or neo-adjuvant chemotherapy, gross margins, frozen section margins, new frozen section margins, permanent margins, reoperation, intra-operative radiotherapy[IOR], tumor type, lympho-vascular invasion, estrogen receptor[ER], progesterone receptor[PR], HER2, metastasis, stage of disease, tumor size, no. of lymph nodes, sentinel lymphnode dissection [SLD] done, number of sentinel lymph node, sentinel lymph node [SLN] frozen section, SLN permanent, completion axillary lymph node dissection [ALND], skin necrosis, numbness, wound infection.

Results: Majority of patients were Saudis (64.5%). 9.1% had previous surgery. Pre menopausal were 43.6% and post menopausal 56.4%. Left breast was involved in 60% and right breast in 40% of cases. Upper outer quadrant was involved in 51.9%9%. Size of mass was less than 1 cm in 14.8% cases, 1-2.9 cm in 43.5%, 3-4 cm in 13%, more than 4 cm in 10.2%. Previous axillary surgery was done in 3.7% cases. Radiological evaluation of axilla was done in 68.2%. Lumpectomy plus sentinel lymph node biopsy was done in 96.4% and lumpectomy and axillary lymph node dissection was done in 1.8% cases, and unspecified BCS in 1.8%. Neo-adjuvant chemotherapy was given in 3.6% and adjuvant chemotherapy in 80% of cases Intra-operative radiotherapy was done in 29.1%. Invasive ductal carcinoma was found in 77.3%, DCIS in 10%, invasive lobular carcinoma in 7.3%, mucinus on 2.7%, medullary in 0.9%, LCIS in 0.9% cases. Lympho-vascular margins were positive in 20.9%. ER were positive in 69.1%, PR were positive in 60%. HER-2 was positive in 26.4% cases. Tumor size was T1 42.7%, T2-42.7%, T3-5.5%, T4-0.9% and carcinoma in situ in 6.4% cases. Lymph nodes were N1-33.6%, N2-4.5%, N0-60.9%. MI-0.9% and MO -98.2%. Sentinel Lymph node biopsy was done in 98.2% of cases. Number of Sentinel lymph nodes retrieved was assessed, two LN in 21.8%, three in 18.2%, one in 17.3%, four in 16.4%, five in 13.6%, six in 6.4%, seven in 1.8%. SLN on frozen section had positive for malignancy in 25.5%, while on permanent section they were positive in 38.2%. Completion axillary dissection was done in 34.5%. Skin necrosis was found in 2.2%, numbness was found in 4.4%, wound infection was in 2.2%.

Conclusion: Methylene blue is effective and safe in the detection of sentinel lymph node in patients with breast cancer and it has low cost and readily available.