Comparison of the sentinel node procedure between patients with multifocal and unifocal breast cancer in the EORTC 10981-22023 AMAROS Trial: Identification rate and nodal outcome

• Published in: European journal of cancer (1990) Vol. 49; no. 9; pp. 2093 - 2100
• Main Authors: Donker, Mila, Straver, Marieke E, van Tienhoven, Geertjan, van de Velde, Cornelis J.H, Mansel, Robert E, Litière, Saskia, Werutsky, Gustavo, Duez, Nicole J, Orzalesi, Lorenzo, Bouma, Willem H, van der Mijle, Huub, Nieuwenhuijzen, Grard A.P, Veltkamp, Sanne C, Helen Westenberg, A, Rutgers, Emiel J.T
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.06.2013; Elsevier
• Subjects: Adult; Aged; Axilla; Biological and medical sciences; Breast cancer; Breast Neoplasms - pathology; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; EORTC; Female; Hematology, Oncology and Palliative Medicine; Humans; Lymph Node Excision - methods; Lymph Nodes - pathology; Lymphatic Metastasis; Medical sciences; Middle Aged; Multifocal; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Pharmacology. Drug treatments; Prospective Studies; Sentinel Lymph Node Biopsy - methods; Sentinel node; Treatment Outcome; Tumors; Multifocal; Sentinel node; Breast cancer; EORTC; Human; Breast disease; Prognosis; Lymph node; Rate; Node; Patient; Identification; Malignant tumor; Mammary gland diseases; Cancerology; Clinical trial; Evolution; Procedure; Mammary gland; Comparative study; Cancer; European Organization for Research and Treatment of Cancer
• ISSN: 0959-8049; 1879-0852
• DOI: 10.1016/j.ejca.2013.02.017

Abstract Introduction Multifocal breast cancer is associated with a higher risk of nodal involvement compared to unifocal breast cancer and the drainage pattern from multifocal localisations may be different. For this reason, the value of the sentinel node biopsy (SNB) procedure for this indication is debated. The aim of the current analysis was to evaluate the sentinel node identification rate and nodal involvement in patients with a multifocal tumour in the EORTC 10981-22023 AMAROS trial. Patients and Methods From the first 4000 registered patients, 342 were identified with a multifocal tumour on histological examination and compared to a randomly selected control group of 684 patients with a unifocal tumour. The outcome of the SNB was assessed. Results The sentinel node was identified in 96% of the patients with a multifocal tumour and in 98% of those with unifocal disease. In the multifocal group, 51% had a metastasis in the sentinel node compared to 28% in the unifocal group; and further nodal involvement after a positive sentinel node was found in 40% (38/95) and 39% (39/101) respectively. Conclusion In this prospective international multicentre study, the 96% detection rate indicates that the SNB procedure can be highly effective in patients with a multifocal tumour. Though the tumour-positive rate of the sentinel node was twice as high in the multifocal group compared to the unifocal group, further nodal involvement after a positive sentinel node was similar in both groups. This suggests that the SNB procedure is safe in patients with multifocal breast cancer.