Widely used in routine for small breast cancers, the sentinel lymph node (SN) biopsy is still discussed in tumors >or= 3 cm.
From 2000 to 2005, 152 patients with invasive breast tumor pT >or= 3 cm had a SN biopsy systematically followed by complete level I/II axillary dissection. Surgery was always the first stage of the treatment. Detection was done after injection of radioisotope followed by a lymphoscintigraphy and injection of Patent Blue. The SN procedure systematically included palpation of the axilla with removal of any enlarged (>1 cm) and/or abnormally firm node even if neither blue nor radioactive. The sentinel lymph node status was compared with the final axillary status.
Tumor size ranged from 30 to 200 mm (median 42 mm). Lymphoscintigraphy was positive in 98% of the cases. At least one labeled sentinel node was retrieved in 97.4% of the patients. The median number of SN cleared out was 2 (range 1-9). The false negative risk was 4% (4/99). The false negative risk was not related to the tumor size and not related to the number of SN removed.
This study shows that the SN procedure is feasible in patients with breast tumors >or= 3 cm with an acceptable false negative risk <5%, similar to false negatives reported for smaller tumors.