Non-visualized sentinel nodes in breast cancer patients; prevalence, risk factors, and prognosis

Nicole C. Verheuvel, Adri C. Voogd, Vivianne C.G. Tjan-Heijnen, S. Siesling, R.H.M. Roumen

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Background: Evidence and consensus is lacking in international guidelines regarding axillary treatment recommendations for patients in whom a sentinel lymph node (SLN) cannot be visualized (non-vSLN) during the sentinel node procedure. In this study we aimed to determine the prevalence of non-vSLNs in a Dutch population of breast cancer patients and to examine predictors and survival rate for non-vSLN.

Methods: A nationwide, retrospective, population-based study was performed including 116,920 patients with invasive breast cancer who underwent a SLN procedure in the Netherlands between January 2005 and December 2013.

Results: Of the 76,472 clinically negative patients who underwent a SLN procedure, 1924 patients (2.5%) had a non-vSLN, of whom 1552 (80.7%) underwent an ALND. Multivariate analysis showed predictive factors for non-vSLN: older age (p < 0.001), diagnosis in the period 2005–2009 (p < 0.001), larger tumor size (p = 0.003), and extensive nodal involvement (p < 0.001). Multivariate survival analysis showed a significantly worse survival (HR 1.18, 95% CI 1.03–1.34, p = 0.015) for non-vSLNs patients. However, in the non-vSLN group, an ALND was not statistically significantly associated with a better survival (HR 0.96, 95% CI 0.53–1.75, p = 0.891).

Conclusion: Patients with non-vSLNs had less favorable disease characteristics and a worse survival compared to patients with a visualized SLN. Performing an ALND was not associated with a significantly better survival in patients with non-vSLNs. However, further research on the necessity of axillary treatment in this specific patient group is required.

Original languageEnglish
Pages (from-to)147-156
Number of pages10
JournalBreast cancer research and treatment
Issue number1
Publication statusPublished - 1 Jan 2018


  • UT-Hybrid-D
  • Non-visualized sentinel nodes
  • Survival
  • Axillary dissection


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