Influence of the New AJCC Breast Cancer Staging System on Sentinel Lymph Node Positivity and False-Negative Rates

• Published in: JNCI : Journal of the National Cancer Institute Vol. 96; no. 11; pp. 873 - 875
• Main Authors: McCready, David R., Yong, Wei Sean, Ng, Alexander K. T., Miller, Naomi, Done, Susan, Youngson, Bruce
• Format: Journal Article
• Language: English
• Published: Cary, NC Oxford University Press 02.06.2004; Oxford Publishing Limited (England)
• Subjects: Axilla; Biological and medical sciences; Breast cancer; Breast Neoplasms - classification; Breast Neoplasms - pathology; Breast Neoplasms - surgery; False Negative Reactions; Female; Gynecology. Andrology. Obstetrics; Humans; Incidence; Lymph Node Excision; Lymph Nodes - pathology; Lymph Nodes - surgery; Lymphatic Metastasis; Lymphatic system; Mammary gland diseases; Medical diagnosis; Medical sciences; Neoplasm Staging; Predictive Value of Tests; Sensitivity and Specificity; Sentinel Lymph Node Biopsy; Tumors; United States; United States; Human; Mammary gland diseases; Cancerology; Lymph node; False negative; Sentinel lymph node; Classification; Malignant lymphadenopathy; Malignant hemopathy; Breast cancer; Malignant tumor; Metastasis
• ISSN: 0027-8874; 1460-2105
• DOI: 10.1093/jnci/djh142

The sixth and newest edition of the American Joint Committee on Cancer (AJCC) staging system for breast cancer now defines axillary sentinel lymph nodes with micrometastatic deposits 0.2 mm in diameter or smaller as node-negative. The aim of this study was to determine how this new classification scheme would affect axillary sentinel lymph node positivity, false-negative rate, and overall accuracy of an inception cohort of 205 breast cancer patients undergoing definitive surgery that included sentinel lymph node biopsy plus level I/II axillary lymphadenectomy. Based on the previous AJCC system for staging breast cancer, in which all sentinel lymph node metastases were considered positive, the rate of nodal positivity in this cohort was 47%, the overall accuracy was 99%, and the false-negative rate was 2.1%. According to the new classification system, the rate of nodal positivity in this cohort was 39.5% and the overall accuracy was 98%. The false-negative rate rose to 4.9% because two patients with micrometastatic deposits 0.2 mm or smaller, which are considered node-negative in the new system, had macroscopically positive disease in non-sentinel lymph nodes found in the completion lymphadenectomy.