Which Hottest Nodes Can Predict Sentinel Lymph Node Metastasis in Breast Cancer?1

BackgroundIn approximately 80% of breast cancer patients, the hottest sentinel lymph nodes (SLNs) can be used to predict nodal metastasis. We correlate the reliability of using these nodes to predict SLN metastasis with different lymphoscintigraphic patterns in breast cancer.MethodsSLN biopsies for T1-2No breast cancer were performed on 467 patients. Lymphoscintigraphic patterns were divided into three groups by the number of draining routes using blue dye and radiocolloid and whether the hottest nodes were the first nodes in the channel.ResultsThe hottest SLNs detected 78 of 87 (90%) cases of SLN metastasis in the 399 patients with successful labeling of both blue dye and radiocolloid in their SLNs. False-negative rates were 0% (single-channel, first node), 58% (multi-channel, first node), and 71% (zero-channel, 0 hottest nodes) (FNR: SingleChanl versus ZeroChanl, P=0.005 and SingleChanl versus MultiChanl, P=0.037; Fisher's exact test).ConclusionsWe recommend a preoperative lymphoscintigram to distinguish the subset of breast-cancer patients with a single draining channel and whose hottest node is the first node.