Sentinel Lymph Node Biopsy in Staging Small (up to 15 mm) Breast Carcinomas. Results from a European Multi-institutional Study

Gábor CSERNI1, Simonetta BIANCHI2, Vania VEZZOSI2, Riccardo ARISIO3, Rita BORI1, Johannes L PETERSE4, Anna SAPINO5, Isabella CASTELLANO5, Maria DRIJKONINGEN6, Janina KULKA7, Vincenzo EUSEBI8, Maria P FOSCHINI8, Jean-Pierre BELLOCQ9, Cristi MARIN9, Sten THORSTENSON10, Isabel AMENDOEIRA11, Angelika REINER-CONCIN12, Thomas DECKER13, Manuela LACERDA14, Paulo FIGUEIREDO14, Gábor FEJES15

1Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
2Department of Human Pathology and Oncology, University of Florence, Florence, Italy
3Department of Pathology, Sant’Anna Hospital, Turin, Italy
4Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
5Department of Biological Science and Human Oncology, University of Turin, Turin, Italy
6Pathologische Ontleedkunde, University Hospitals Leuven, Leuven, Belgium
72nd Department of Pathology, Semmelweis University, Budapest, Hungary
8Sezione Anatomia Patologica M. Malpighi, Universita di Bologna, Ospedale Bellaria, Bologna, Italy
9Service d’Anatomie Pathologique, Hopital de Hautepierre, Strasbourg, France
10Department of Pathology and Cytology, Kalmar Hospital, Kalmar, Sweden
11Instituto de Patologia e Imunologia, Universidade do Porto (IPATIMUP) and Hospital de S. Joao, Porto, Portugal
12Institute of Pathology, Donauspital, Wien, Austria
13Gerhard-Domagk Institut fur Pathologie, Universitat von Munster, Munster, Germany
14Laboratorio De Histopatologica, Centro Regional De Oncologia De Coimbra, Coimbra, Portugal
15Department of Informatics, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary


Sentinel lymph node (SLN) biopsy has become the preferred method for the nodal staging of early breast cancer, but controversy exists regarding its universal use and consequences in small tumors. 2929 cases of breast carcinomas not larger than 15 mm and staged with SLN biopsy with or without axillary dissection were collected from the authors’ institutions. The pathology of the SLNs included multilevel hematoxylin and eosin (HE) staining. Cytokeratin immunohistochemistry (IHC) was commonly used for cases negative with HE staining. Variables influencing SLN involvement and non-SLN involvement were studied with logistic regression. Factors that influenced SLN involvement included tumor size, multifocality, grade and age. Small tumors up to 4 mm (including in situ and microinvasive carcinomas) seem to have SLN involvement in less than 10%. Non-SLN metastases were associated with tumor grade, the ratio of involved SLNs and SLN involvement type. Isolated tumor cells were not likely to be associated with further nodal load, whereas micrometastases had some subsets with low risk of non-SLN involvement and subsets with higher proportion of further nodal spread. In situ and microinvasive carcinomas have a very low risk of SLN involvement, therefore, these tumors might not need SLN biopsy for staging, and this may be the approach used for very small invasive carcinomas. If an SLN is involved, isolated tumor cells are rarely if ever associated with non-SLN metastases, and subsets of micrometastatic SLN involvement may be approached similarly. With macrometastases the risk of non-SLN involvement increases, and further axillary treatment should be generally indicated. Pathology & Oncology Research, Vol 13, Nr 1, 5-14, 2007

Key words: Sentinel lymph node; non-sentinel lymph node; breast cancer; pT1

Received: Nov 29, 2006; accepted: Jan 29, 2007
Correspondence: Gábor CSERNI, Department of Pathology, Bács-Kiskun County Teaching Hospital, Nyiri út 38 Kecskemét H-6000, Hungary; Tel: +36-76-516768, Fax: +36-76-481219; E-mail:

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