Predictive factors for additional non-sentinel lymph node involvement in breast cancer patients with one positive sentinel node



The aim of this study was to identify a subgroup of breast cancer patients in whom it is possible to avoid axillary lymph node dissection (ALND) when the sentinel lymph node (SLN) is positive.


A series of 292 patients treated with breast-conserving surgery or mastectomy underwent ALND after positive SLN detection. To correlate SLN metastasis with the chances of finding additional metastasis in non-SLNs we evaluated the main clinicopathological characteristics. No patients received adjuvant radiotherapy to the axillary region.


Fifty-six patients (35.4%) with positive SLNs for macrometastases (n = 158) had additional metastases upon completion ALND compared with 7 patients (5.2%) with micrometastases in the SLN (n = 132). Cases with a higher number of positive axillary lymph nodes tended to have higher pT stage (p = 0.004). In multivariate analysis, pT was confirmed as an independent predictor of non-SLN metastases (OR = 2.40; 95% CI = 1.16-4.99). No patients with micrometastases in SLN and cancer <10 mm had additional positive non-SLNs.


Our results, in agreement with the major published studies, suggest that ALND can be avoided in selected patients without the need for additional treatment to the axillary region.

Tumori 2015; 101(1): 78 - 83




Icro Meattini, Calogero Saieva, Silvia Bertocci, Giulio Francolini, Giacomo Zei, Carla De Luca Cardillo, Vieri Scotti, Daniela Greto, Pierluigi Bonomo, Lorenzo Orzalesi, Simonetta Bianchi, Lorenzo Livi

Article History


Financial support: None declared.
Conflict of interest: None declared.

This article is available as full text PDF.

  • If you are a Subscriber, please log in now.

  • Article price: Eur 36,00
  • You will be granted access to the article for 72 hours and you will be able to download any format (PDF or ePUB). The article will be available in your login area under "My PayPerView". You will need to register a new account (unless you already own an account with this journal), and you will be guided through our online shop. Online purchases are paid by Credit Card through PayPal.
  • If you are not a Subscriber you may:
  • Subscribe to this journal
  • Unlimited access to all our archives, 24 hour a day, every day of the week.



  • Department of Radiation-Oncology, University of Florence, Florence - Italy
  • Molecular and Nutritional Epidemiology Unit, ISPO (Cancer Research and Prevention Institute), Florence - Italy
  • Department of Surgery, University of Florence, Florence - Italy
  • Division of Pathological Anatomy, Department of Medical and Surgical Critical Care, University of Florence, Florence - Italy

Article usage statistics

The blue line displays unique views in the time frame indicated.
The yellow line displays unique downloads.
Views and downloads are counted only once per session.

No supplementary material is available for this article.