Intraoperative identification of suspicious palpable lymph nodes as an integral part of sentinel node biopsy in patients with breast cancer

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Abstract
Despite the sensitivity and accuracy of sentinel lymph node biopsy (SLNB), the number of false negative (FN) results is still relatively high, which has prompted much investigation. We studied the effectiveness of the biopsy of suspicious palpable lymph nodes (LNs) in reducing the number of FN results. We reviewed the medical records of 865 breast cancer patients who underwent successful SLNB at a single institution. After excising the blue-stained or radioactive nodes, all suspicious palpable LNs that were not either blue-stained or radioactive were also excised. Sampling of a suspicious palpable LN was done in 342 (39.5%) of the 865 patients. The average number of suspicious palpable nodes was 1.9. The suspicious nodes harbored metastasis in 19 of the 342 patients. Both blue-stained and radioactive metastatic SLNs were found in 8 patients, whereas the palpable nodes were the only ones involved in the other 11. LN involvement was identified solely by biopsy of a suspicious palpable LN in 11 (6.5%) of 170 patients with SLN metastasis (6.5%). Biopsy of a suspicious palpable LN should be done as part of SLNB to reduce the number of FN results of SLNs in breast cancer patients.