Evaluation of patients with the breast conserving surgery and lymph node biopsy in the long term follow-up

Background: Through the increased screening programmes, it is possible to confirm breast cancer in early stages. Modified radical mastectomy was the recommended treatment but recently it is necessary to make less invasive techniques. Despite high morbidities of axillary dissection, axillary nodal status is still one of the most important prognostic factors in breast cancer. Sentinel lymph node biopsy is less invasive technique with high safety for axillary staging, and decreases the unnecessary axillary dissections. However, with false negativity rates of %1-%14, it can cause inadequate treatments.Method: From January 2002 to April 2010, 172 patients with primary breast cancer who underwent breast conserving surgery with sentinel lymph node biopsy and IHK results were negative, included in this study. Recurrence rates, general survival rates, survival with no sickness rates and influence factors on prognosis and morbidity rates were computed.Results: In 172 patients, median age was 53,57±12,45, median tumor diameter was 18,80 mm and 68% of patients were T1, 31,4% were T2 and 0,6% were T3. Pathological results showed IDK in 135 patients (78,5%), ILK in 16 patients (9,3%) and other type breast carcinoma in 21 patients (12,2%). 29 patients were (17%) grade I; 64 patients were (37%) grade II; 79 patients were (46%) grade III. Median sentinel lymph node number was 2 (1-5), parafine results were negative for 169 patients (98,3%) while isolated tumor cell was seen in 3 patients (1,7%). Estrogen receptors were positive for 135 patients (78,5%) and negative for 37 patients (21,5%). Progesteron receptors were positive for 123 patients (71,5%), negative for 49 patients (28,5%). Cerb-B2 score was negative in 152 patients (88,4%); positive in 20 (11,6%) patients. In an average of 4 years (48 months) follow-up period; local-regional recurrence was seen in 4 patients (2,3%) and distant organ metastasis was seen in 7 patients (4,1%). 3 of the 4 patients with local-regional recurrence were local (breast) while 1 patient in the axillary areas. Six (3,5%) patients were lost during the follow-up period; cause of death was breast cancer on 4 patients (2,3%), other causes on 2 patients (1,2%). 3 and 5 year survival rates of the patients were 99,2% and 96,7 respectively. Survival with no sickness rates were computed as 95,7% and 94% respectively. The study showed that the modified SBR grade of the tumor, multifocality and estrogen receptor status have affect on the survival with no sickness rates.Conclusion: In experienced hands, SLND is an effective way of assessing axillary nodal status with minimal morbidity and high accuracy and can be a safe management for selected patients with early-stage breast cancer, with long survival rates and low recurrence.