Intraoperative Nodal Palpation is a Mandatory Component of Sentinel Lymph Node Biopsy for Breast Cancer IOP node palpation

Masakuni Noguchi (1), Masafumi Inokuchi (2), Emi Morioka (3), Yusuke Haba (4), Akihiro Shioya (5), Sohsuke Yamada (6), Yasuo Iida (7)
(1) Department of Breast Surgery Kanazawa Medical University Hospital, Japan,
(2) Department of Breast and Endocrine Surgery, Breast Center, Kanazawa Medical University Hospital, Uchinada, Ishikawa, Japan, Japan,
(3) Department of Breast and Endocrine Surgery, Breast Center, Kanazawa Medical University Hospital, Uchinada, Ishikawa, Japan, Japan,
(4) Department of Breast and Endocrine Surgery, Breast Center, Kanazawa Medical University Hospital, Uchinada, Ishikawa, Japan, Japan,
(5) Department of Clinical Pathology, Kanazawa Medical University Hospital, Uchinada, Ishikawa, Japan, Japan,
(6) Department of Clinical Pathology, Kanazawa Medical University Hospital, Uchinada, Ishikawa, Japan, Japan,
(7) Department of Mathematics, General education, Kanazawa Medical University, Uchinada, Ishikawa, Japan, Japan

Abstract

Background: In the era of Z-0011, it is mandatory to decrease not only the false negative rate (FNR) of sentinel lymph node (SLN) biopsy but also the risk of residual metastatic nodes after SLN biopsy.


Method: SLN biopsy with intraoperative nodal palpation (INP) was performed in patients with clinically node-negative (cN0) breast cancer. All identified blue and hot nodes were removed as blue/hot SLNs, and any suspicious palpable nodes were removed as palpable SLNs. Nodes that were incidentally removed with neighboring the blue/hot SLNs were classified as para-SLNs. Patients with positive SLNs on frozen section underwent axillary lymph node dissection (ALND) except for patients who met the Z-0011 and AMAROS criteria for exemption.


Results: Palpable SLNs and para-SLNs were identified in 202 patients. Of 200 patients, excluding 2 patients only with palpable SLNs, 46 patients had involvements of blue/hot SLNs, and 14 had palpable and para-SLNs harboring additional metastasis. When false negative rate (FNR) was calculated based on blue/hot SLNs and palpable SLNs, the additional use of INP resulted in a FNR of 45.2%. Subsequently, ALND was performed in 43 patients with positive blue/hot or palpable SLNs. Residual nodal involvement was found in 28 (65%) of 43 patients after removing blue/hot SLNs. However, after removing palpable SLNs, the rate of residual nodal metastases significantly decreased from 65% (28/43) to 36% (13/36) (p=0.0133).


Conclusion: INP decreased both the FNR of SLN biopsy and the risk of residual metastatic nodes after SLN biopsy.

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References

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Authors

Masakuni Noguchi
nogumasa@kanazawa-med.ac.jp (Primary Contact)
Masafumi Inokuchi
Emi Morioka
Yusuke Haba
Akihiro Shioya
Sohsuke Yamada
Yasuo Iida
1.
Noguchi M, Inokuchi M, Morioka E, Haba Y, Shioya A, Yamada S, Iida Y. Intraoperative Nodal Palpation is a Mandatory Component of Sentinel Lymph Node Biopsy for Breast Cancer: IOP node palpation. Arch Breast Cancer [Internet]. [cited 2024 Jul. 14];11(3). Available from: https://www.archbreastcancer.com/index.php/abc/article/view/969

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