BACKGROUND: During @entity1600 ( @entity1600 ) biopsy for @entity0 , most authors report identifying a mean of 1 to 3 SLNs, but a range of 1 to 8 (or more) SLNs per @entity1 . A significant minority of @entity1 have 4 or more SLNs. Here we seek to determine the significance for the @entity0 @entity1 of finding multiple SLNs, and whether there is an optimal threshold number of SLNs that should be removed. STUDY DESIGN: 1,561 @entity1 who underwent successful @entity1600 biopsy using blue dye and radioisotope in combination. Each @entity1600 site was categorized prospectively by the operating surgeon as a dye success, an isotope success, or both. All SLNs containing counts at least four times greater than the postexcision axillary background were considered to be isotope successes. RESULTS: Fifteen percent of @entity1 (241) had multiple (>3) SLNs. Ninety-eight percent of node-positive @entity1 (440 of 449) were identified within the first three @entity1600 sites examined. In 2% of all @entity1600 positive @entity1 (9 of 449) or 4% of @entity1 with multiple @entity1600 (9 of 241), a positive @entity1600 was detected at site four or more. In eight @entity1 the first positive @entity1600 was found at sites four or more. Blue dye and isotope were equally effective in identifying @entity3 in @entity1 with multiple SLNs. CONCLUSIONS: Fifteen percent of @entity1 having @entity1600 biopsy for @entity0 have multiple SLNs. Although 98% of positive SLNs were identified within the first three sites sampled, a small number of @entity1 had their first positive @entity1600 at sites 4 to 8. These data suggest that there is no absolute upper threshold for the number of SLNs that should be removed. Sampling a few additional SLNs probably adds little morbidity to the procedure, yet may significantly alter the treatment of some individuals. @entity1600 biopsy should be continued until all blue and hot nodes are removed.

The XXXX @entity1 with multiple sentinel nodes: when to stop?

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity1600 :: ('MESH:D014388', 'Disease') :: ['sentinel lymph node', 'SLN'] @entity0 :: ('MESH:D001943', 'Disease') :: ['breast cancer'] @entity3 :: ('MESH:D009362', 'Disease') :: ['metastases']
@entity0 :: (MESH:D001943,Disease) :: ['breast cancer']
