Factors causing failure of the sentinel node technique in mammary tumors larger than 4 cm without clinical axillary invasion

Introduction

The high detection rate of the sentinel lymph node (SLN) in breast cancer is a quality criterion of the procedure. The aim of our work is to identify the failure factors (FF) of the SLN biopsy in tumors larger than 4 cm.

Material and methods

This is a prospective series of patients with breast tumors larger than 4 cm without clinical axillary involvement. The colorimetric method was used in 52% of cases and the dual method in 48% of cases.

Results

The failure rate (FR) is 13%. The FF with a statistically significant difference are axillary invasion (P: .03; OR: 6.58) and the presence of lympho-vascular emboli (LVE) (P < .05; OR: 4.95). It should be noted that lympho-vascular emboli only concern those found in the peri-tumoral area. On the other hand, age over 60 years, Body mass index (BMI) over 30 and Ki 67 over 14 are not determining factors.

Discussion

Sener finds a more important FR when more than 10 lymph nodes of the axillary dissection are reached compared to the axillary hollows free from any neoplastic infiltration (P: .002; OR: 9.19). The FR for Gimbergues was statistically correlated with lymph node status (0% for pN0 tumors, versus 55% for pN1–N2 tumors). For Brenot-Rossi, the existence of LVE is a significant failure factor (P = .004).

For other factors (obesity, advanced age), the data in the literature are contradictory.

Conclusion

The infiltration of the axillary fossa and the existence of LVE constitute the main FF of SLN biopsy in patients with tumors larger than 4 cm without clinical axillary invasion.