Mastectomy and concomitant sentinel lymph node biopsy for invasive breast cancer

Sabel, Michael S; Degnim, Amy; Wilkins, Edwin G; Diehl, Kathleen M; Cimmino, Vincent M; Chang, Alfred E; Newman, Lisa A

doi:10.1016/j.amjsurg.2003.10.016

« Previous Next »The American Journal of Surgery
Volume 187, Issue 6 , Pages 673-678, June 2004

Mastectomy and concomitant sentinel lymph node biopsy for invasive breast cancer

Michael S Sabel, M.D.
- Division of Surgical Oncology, University of Michigan Comprehensive Cancer Center, 3304 Cancer Center, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA
- Corresponding author. Tel.: +1-734-936-5827; fax: +1-734-947-9647
Amy Degnim, M.D.
- Division of Surgical Oncology, University of Michigan Comprehensive Cancer Center, 3304 Cancer Center, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA
Edwin G Wilkins, M.D.
- Department of Plastic Surgery, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
Kathleen M Diehl, M.D.
- Division of Surgical Oncology, University of Michigan Comprehensive Cancer Center, 3304 Cancer Center, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA
Vincent M Cimmino, M.D.
- Division of Surgical Oncology, University of Michigan Comprehensive Cancer Center, 3304 Cancer Center, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA
Alfred E Chang, M.D.
- Division of Surgical Oncology, University of Michigan Comprehensive Cancer Center, 3304 Cancer Center, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA
Lisa A Newman, M.D., M.P.H.
- Division of Surgical Oncology, University of Michigan Comprehensive Cancer Center, 3304 Cancer Center, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA

Received 22 July 2003; received in revised form 17 October 2003

Abstract

Background

Although sentinel lymph node biopsy (SNLB) has become a standard ancillary to breast conservation, there remains a hesitancy to perform SLNB concomitant with mastectomy primarily because of concerns regarding reoperation for a positive SLN.

Methods

A retrospective review of 51 patients who underwent SLN biopsy concomitantly with mastectomy for invasive breast cancer was performed. In addition, a survey was sent to surgical oncologists who routinely perform SLNB in conjunction with mastectomy.

Results

The SLN was identified in 98% of patients, and an average of 2.4 SLNs/patient were removed. The SLN was positive in 14 patients (27%). Ten patients underwent axillary lymph node dissection as a second procedure; an average of 15.4 ± 6 nodes were cleared, and there were no complications. Although techniques vary greatly among surgeons, the majority believe that a subsequent ALND procedure does not carry additional risk of morbidity.

Conclusions

Mastectomy and concomitant SLNB is a safe option for well-selected breast cancer patients. Results appear acceptable using a variety of techniques. Patients with a positive SLN can safely undergo completion axillary lymph node dissections. This includes patients who have undergone immediate reconstruction, but proper planning is needed to minimize potential risks.

Keywords: Mastectomy, Sentinal lymph node biopsy