Evaluation of axillary lymph node metastasis in relation to size and metastatic status of sentinel lymph node in carcinoma breast


  • Vineet Kumar Pandey Department of Surgery, Maulana Azad Medical College, New Delhi, India
  • Deepak Ghuliani Department of Surgery, Maulana Azad Medical College, New Delhi, India
  • Sushanto Neogi Department of Surgery, Maulana Azad Medical College, New Delhi, India
  • Nita Khurana Department of Pathology, Maulana Azad Medical College, New Delhi, India
  • R. K. Jindal Department of Surgery, Maulana Azad Medical College, New Delhi, India




Carcinoma breast, Sentinel lymph node biopsy, Axillary lymph node dissection, Macrometastasis


Background: Sentinel lymph node (SLN) is the first node in the nodal basis of a tumor and the most likely site for earliest lymph node metastasis. Modified radical mastectomy with axillary lymph node dissection (ALND) has been the standard of care for carcinoma breast. The SLN is the only involved node in majority (40-70%) of the patients undergoing ALND for a positive SLN biopsy. ALND is associated with significant morbidities like seroma, infection, lymphedema and nerve injury. The purpose of this study was to evaluate the axillary node metastasis with respect to the size and tumoral load of positive SLN.

Methods: Thirty patients of biopsy proven early breast carcinoma underwent SLN biopsy with methylene blue dye followed by modified radical mastectomy (MRM). After measuring the size of the SLN with Vernier caliper, SLN and MRM specimen were sent for histopathological examination. Status of non-sentinel ALNs was compared with the size and tumoral load of SLN.

Results: Among 30 patients, 5 patients had positive SLN. Patients with positive SLNs were younger (mean 36 vs. 52 years), had larger diameter (10.8 vs. 7.4 mm, p<0.03) with higher number of non-sentinel ALN metastasis (35% vs. 4.86%). Macrometastasis in positive SLN was associated with higher risk of metastasis to non-sentinel ALNs.

Conclusions: A SLN size of more than 7.5mm has higher risk of harboring metastasis. A SLN size higher than 10mm and macrometastasis is associated higher risk of metastasis to non-sentinel ALNs.


Author Biography

Vineet Kumar Pandey, Department of Surgery, Maulana Azad Medical College, New Delhi, India

Post Graduate Resident Doctor


Illyes I, Tokes AM, Kovacs A, Molnar BA, Szasz AM, Kaszas I et al. In breast cancer patients sentinel lymph node metastasis characteristics predict further axillary involvement. Virchows Arch. 2014;465:15-24.

Schwartz GF, Giuliano AE, Veronesi U. Proceedings of the consensus conference on the role of sentinel lymph node biopsy in carcinoma of the breast, April 19–22, 2001, Philadelphia, Pennsylvania. Cancer. 2002;94:2542–51.

Oz B, Akcan A, Dogan S, Abdul Razzak U, Aslan D, Sozuer E, et al. Prediction of non-sentinel lymph node status in breast cancer patients with only one sentinel lymph node metastasis. Asian J Surg. 2018;1:12-9.

Giuliano AE, Jones RC, Brennan M, Statman R. Sentinel lymphadenectomy in breast cancer. J Clin Oncol. 1997;15:2345-50.

Reynolds C, Mick R, Donohue JH, Grant CS, Farley DR, Callans LS, et al. Sentinel lymph node biopsy with metastasis: can axillary dissection be avoided in some patients with breast cancer? J Clin Oncol. 1999;17:1720–6.

Cserni G. Sentinel lymph-node biopsy-based prediction of further breast cancer metastases in the axilla. Eur J Surg Oncol. 2001;27:532–8.

Hwang RF, Krishnamurthy S, Hunt K, Mirza N, Ames FC, Feig B, et al. Clinicopathologic factors predicting involvement of non-sentinel axillary nodes in women with breast cancer. Ann Surg Oncol. 2003;10:248–54.

Edge SB, Byrd DR, Compton CC, Fritz AG, Green FL, Trotti A. AJCC cancer staging manual (7th edition). New York: Springer; 2010.

Kaarthigeyan K. Cervical cancer in India and HPV vaccination. Indian J Med Paediatr Oncol. 2012;33:7-12.

Giuliano AE, Kirgan DM, Guenther JM, Mortan DL. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg. 1994;220:391-401.

Albertini JJ, Lyman GH, Cox C, Yeatman T, Balducci L, Ku N, et al. Lymphatic mapping and sentinel node biopsy in patients with breast cancer. JAMA. 1996;276:1818-22.

Pijpers R, Meijer S, Hoekstra OS, Callet GJ, Comans EF, Boom RP, et al. Impact of lymphoscintigraphy on sentinel node identification with technetium-99m-colloid albumin in breast cancer. J Nucl Med. 1997;38:366-8.

Viale G, Maiorano E, Pruneri G, Mastropasqua MG, Valentini S, Galimberti V, et al. Predicting the risk for additional axillary metastases in patients with breast carcinoma and positive sentinel lymph node biopsy. Ann Surg. 2005;241:319-25.

Pagnanelli G, Bono R, Pizzichetta MA. Clinical and dermoscopic criteria related to melanoma sentinel lymph node positivity. Anicancer Res. 2007;27:2939-44.






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