Awareness of Lymphatic Anatomy to Decrease False Negative Sentinel Lymph Node Rate in Breast Cancer

Excerpt

Sentinel node (SN) biopsy is now routinely performed for breast cancer patients. It was first described 40 years ago by Ernest Gould et al. [1]. SN biopsy in breast cancer is performed to avoid the morbidity of axillary lymph node dissection (ALND). SLN (sentinel lymph node) procedure requires identification and resection of the first lymph nodes upon which the primary tumor drains. Subsequently SLN undergoes frozen section examination to see if node is involved or not. This predicts chance of metastases to other nodes and dictates the need for axillary node dissection and further adjuvant treatment. SLN has high sensitivity and specificity, but studies have demonstrated a failure rate of 5%. To have a good oncological outcome, false negative rates should be very low. False negative means we are leaving behind malignant node in axilla and assuming status of axilla to be negative for malignancy. A false negative result leads to the undertreatment of patients. The good outcome of SLN depends on surgeon’s expertise and knowledge of anatomy of lymphatic’s [2]. False negative SNs are because of technical failures, which may arise because of not removing and later examining true SN. The surgeon should be familiar with the anatomy of the lymphatic of breast to avoid this technical error. We present a rare presentation of multiple route–multiple SLN with reviews of different lymphatic routes, which a patient can present with the surgeon. …