Sentinel Lymph Node Biopsy in Multifocal or Multicentric

Sentinel Lymph Node Biopsy in Multifocal or Multicentric Breast Cancer An approach by subareolar injection of blue dye Dae-Kyum Kim, Sang-Uk Woo, Jeong-Han Kim, Seok-Jin Nam, and Jung-Hyun Yang Department of Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine

Introduction • Multicentric/Multifocal breast cancers have generally been considered to be a contraindication to sentinel lymph node biopsy (SLNB) (Veronesi et al 1997, Lancet) - A precise injection site of dye? - A greater likelihood of a technical failure?

• Klimberg et al (1999, Ann Surg) Equal identification rate of the SLNB for the subareolar injection site and the peritumoral injection site • Schrenk and Wayand (2001, Lancet) The subareolar injection and multicentric breast cancer

Methods • Between Oct. 2003 and Sep. 2004 at Samsung Medical Center • 19 patients who was diagnosed as multifocal (MF)/multicentric (MC) invasive breast cancer preoperatively • Invasiveness of the satellite cancers • MF/MC MC : more than two tumors greater than 5 cm apart or in separate quadrants of the breast • SLNB by subareolar injection of blue dye only and conventional axillary lymph node dissection was performed

5 cc of isosulfan blue dye was injected four site under subareolar area. After 5~10 min, an axillary incision was made

Results 1. Multicentric Cancers and Multifocal Cancers No. of patients

2. Tumor Size T 1 T 2 Total MC (%) 4 (57. 1) 3 (42. 9) 7 (100. 0) MF (%) 10 (83. 3) 2 (16. 7) 12 (100. 0) Total(%) 14 (73. 3) 5 (26. 3) 19 (100. 0)

3. EIC yes no Total MC (%) 4 (57. 1) 3 (42. 9) 7 (100. 0) MF (%) 4 (33. 3) 8 (66. 7) 12 (100. 0) Total(%) 8 (42. 1) 11 (57. 9) 19 (100. 0)

4. Endolymphatic Tumor Emboli yes no Total MC (%) 1 (14. 3) 6 (85. 7) 7 (100. 0) MF (%) 3 (25. 0) 9 (75. 0) 12 (100. 0) Total(%) 4 (21. 1) 15 (78. 9) 19 (100. 0)

5. Pathology MC (%) MF (%) IDC* 7 (100. 0) 11 (91. 7) Other† 0 ( 0. 0) 1 ( 8. 3) Total 7 (100. 0) 12 (100. 0) *invasive ductal cancer †invasive cribriform carcinoma Total(%) 18 (94. 7) 1 ( 5. 3) 19 (100. 0)

6. Postoperative Pathology of Satellite lesions in MC/MF Cancers No. of patients

7. N stage N 0 N 1 N 2 Total MC (%) 5 (71. 4) 1 (14. 3) 7 (100. 0) MF (%) 7 (50. 0) 2 (16. 7) 3 (25. 0) 12 (100. 0) Total(%) 12 (63. 2) 3 (15. 8) 4 (21. 0) 19 (100. 0)

8. N stage with Noninvasive* Satellite Lesions N 0 N 1 * DCIS No. of patients (%) 3 (100. 0%) 0 (0. 0)

9. Lymphatic Mapping Results Successful identified SLNB Mean No. of SLN-only metastases in axilla Sensitivity Accuracy False-negative rate (%) 19/19 (100. 0) 2. 3 2/ 7 ( 28. 6) 7/ 7 (100. 0) 19/19 (100. 0) 0/19 ( 0. 0)

Conclusions • SLNB may accurately stage the axilla in multifocal or multicentric breast cancer. • If noninvasive lesions of satellite cancers are considered preoperatively, more accurate SLNB may be possible in multifocal or multicentric lesions. • The subareolar injection of blue dye may be reliable method in multifocal or multicentric breast cancer.