Axillary metastases in breast cancer patients with negative sentinel nodes: a follow-up of 3548 cases

Eur J Cancer. 2009 May;45(8):1381-8. doi: 10.1016/j.ejca.2008.11.041. Epub 2009 Jan 6.


PREMISES: Sentinel node biopsy (SNB) in patients with breast carcinoma accurately predicts the axillary node status. However, in some 4-7% of patients with negative sentinel nodes, the remaining axillary nodes harbour cancer cells.

Objective: Our purpose was the long-term observation of a large number of patients who did not receive axillary dissection after a negative sentinel node biopsy, in order to evaluate the incidence of overt axillary metastases.

Methods: Patients (3548) treated from 1996 to 2004, with negative sentinel nodes not submitted to axillary dissection, were followed up to 11 years with a median follow-up of 48 months.

Results: Three hundred and sixteen unfavourable events occurred among the 3548 patients, 196 of which (5.5%) related to primary breast carcinoma. Thirty one cases of overt axillary metastases were found (0.9%): they received total axillary dissection and 27 of them are at present alive and well. The 5-year overall survival rate of the whole series was 98%.

Conclusions: Patients with negative sentinel node biopsy not submitted to axillary dissection show, at follow-up, a rate of overt axillary metastases lower than expected.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Axilla
  • Breast Neoplasms / mortality
  • Breast Neoplasms / pathology*
  • Breast Neoplasms / therapy
  • Carcinoma, Ductal, Breast / mortality
  • Carcinoma, Ductal, Breast / secondary*
  • Carcinoma, Ductal, Breast / therapy
  • Combined Modality Therapy
  • Female
  • Follow-Up Studies
  • Humans
  • Kaplan-Meier Estimate
  • Lymphatic Metastasis
  • Middle Aged
  • Proportional Hazards Models
  • Receptors, Estrogen / analysis
  • Reoperation
  • Risk
  • Sentinel Lymph Node Biopsy
  • Survival Rate
  • Treatment Outcome


  • Receptors, Estrogen