Multicentric Breast Cancer and Sentinel Node Biopsy

Comment on article published in The Journal of Clinical Oncology: Knauer M et al.: "Multicentric Breast Cancer: A New Indication for Sentinel Node Biopsy-A Multi-Institutional Validation Study", J Clin Oncol. 2006 Jul 20;24(21):3374-80

As the main conclusion in our paper multicentric breast cancer constitutes a new indication for SNB only without axillary dissection. Our studies and the work of Goyal, Tousimis and Layeeque are giving encouraging results for this approach even though the follow-up times are too short for recommending it without adequate quality control. False negative rates were as low as 3.2% for subareolar dye or radiocolloid injections versus 4.0% for all patients and met the required standards. One point of improvement should be the standardization of the SNB procedure especially in multicentric cancer because in our patients for example the strict concordance of “blue and hot” nodes was only 68 percent which underlines in our opinion the need for combined injections of blue dye and radiocolloid. The clinical advantage for our patients except the more accurate N-staging in SNB is that every third woman with multicentric cancer benefits from SNB and can at least be spared the morbidity of axillary dissection if not mastectomy.