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Optimal use of sentinel lymph node biopsy versus axillary lymph node dissection in patients with breast carcinoma
A decision analysis
Article first published online: 22 JUL 2002
Copyright © 2002 American Cancer Society
Volume 95, Issue 3, pages 478–487, 1 August 2002
How to Cite
Wong, S. L., Abell, T. D., Chao, C., Edwards, M. J. and McMasters, K. M. (2002), Optimal use of sentinel lymph node biopsy versus axillary lymph node dissection in patients with breast carcinoma. Cancer, 95: 478–487. doi: 10.1002/cncr.10696
- Issue published online: 23 JUL 2002
- Article first published online: 22 JUL 2002
- Manuscript Revised: 12 MAR 2002
- Manuscript Accepted: 12 MAR 2002
- Manuscript Received: 1 FEB 2002
- Center for Advanced Surgical Technology (CAST), Norton Hospital, Louisville, KY
- sentinel lymph node biopsy;
- axillary lymph node dissection;
- breast carcinoma
There are no data available from randomized controlled trials that compare the efficacy of sentinel lymph node (SLN) biopsy with Level I/II axillary lymph node dissection (ALND) in patients with breast carcinoma. We performed a formal decision analysis to determine whether SLN biopsy is appropriate, compared with ALND, for patients with T1, T2, and T3 tumors and to quantify the relative value of these two procedures in the management of patients with breast carcinoma.
All clinically relevant outcomes were modeled for both SLN biopsy and ALND. The probabilities of complications and outcomes were derived using data from the University of Louisville Breast Cancer Sentinel Lymph Node Study and from extensive review of previous studies. Utilities were assigned by the authors, incorporating values from the literature whenever possible.
The expected utility of SLN biopsy was higher than the expected utility for ALND for T1 and T2 tumors that were 4.0 cm or smaller. There was no clear preference for either procedure with tumors that were larger than 4.0 cm. The T1 and T2 results were robust to sensitivity analysis.
The results of this decision analysis suggest that SLN biopsy is preferred over ALND for patients with breast tumors that are 4.0 cm or smaller. Patients should be aware of the potential for false-negative results in SLN biopsy, but this risk is outweighed by the decreased morbidity associated with the procedure itself. Cancer 2002;95:478–87. © 2002 American Cancer Society.