Original article Positive versus negative sentinel nodes in early breast cancer patients: Axillary or loco-regional relapse and survival. A study spanning 2000e2012 A. García Fernández a, b, * , C. Chabrera c, d , M. García Font e , M. Fraile f , J.M. Lain g , I. Barco a , C. González h , S. Gónzalez i , A. Reñe j , E. Veloso k , J. Cassadó l , A. Pessarrodona l , N. Giménez m, n a Breast Unit, Department of Gynecology, CTD, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Spain b Department of Gynecology, Catalan Institute of Health, Mollet del Vallès, Barcelona, Spain c Department of Nursing, School of Health Science TecnoCampus Mataró-Maresme, Spain d Department of Hemato-oncology, Catalan Institute of oncology, Spain e University International of Catalunya, Spain f Nuclear Medicine Department, CTD, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Spain g Breast Unit, Department of Gynecology, Hospital of Terrassa, Health Consortium of Terrassa, Spain h Department of Pathology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Spain i Department of Hemato-oncology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Spain j Department of Radiology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Spain k Department of Surgery, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Spain l Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Spain m Research Unit, Research Foundation Mútua Terrassa, University of Barcelona, Spain n Laboratory of Toxicology, Universitat Autònoma de Barcelona, Spain article info Article history: Received 29 January 2013 Received in revised form 9 April 2013 Accepted 17 April 2013 Keywords: Breast neoplasms Sentinel lymph node biopsy Survival Mortality Neoplasm recurrence abstract Sentinel Node Biopsy (SNB) is a minimally invasive alternative to elective axillary lymph node dissection (ALND) for nodal staging in early breast cancer. The present study was conducted to evaluate prognostic implications of a negative sentinel node (SN) versus a positive SN (followed by completion ALND) in a closely followed-up sample of early breast cancer patients. We studied 889 consecutive breast cancer patients operated for 908 primaries. Patients received adjuvant therapy with chemotherapy, hormone therapy and eventually trastuzumab. Radiation therapy was based on tangential radiation fields that usually included axillary level I. Median follow-up was 47 months. Axillary recurrence was seen in 1.2% (2/162) of positive SN patients, and 0.8% (5/625) of negative SN patients (p ¼ n.s.). There was an overall 3.2% loco-regional failure rate (29/908). Incidence of distant recurrence was 3.3% (23/693) for negative SN patients, and 4.6% (9/196) for positive SN patients (p ¼ n.s.). Overall mortality rate was 4% (8/198) for positive SN patients, while the corresponding specific mortality rate was 2.5% (5/198). For patients with negative SNs, overall mortality was 4.9% (34/693), and the specific mortality was 1.4% (19/693) (p ¼ n.s.). We did not find significant differences in axillary/loco-regional relapse, distant metastases, disease- free interval or mortality between SN negative and SN positive patients, with a follow-up over 4 years. Ó 2013 Elsevier Ltd. All rights reserved. Introduction Lymph node status is a well-established prognostic factor in breast cancer patients. 1e3 Nonetheless, axillary lymph node dissec- tion (ALND) as the classical procedure for node staging has several, well-known drawbacks: lymphedema, pain, limited shoulder movement and others. 4e8 Sentinel Node Biopsy (SNB) is a minimally invasive alternative to elective ALND, with very low morbidity and * Corresponding author. OTC, Programa detección Precoz Cáncer de Mama, Uni- versity Hospital of Mútua Terrassa, University of Barcelona, C/ Sant Antoni 20, 08221 Terrassa, Barcelona, Spain. Tel.: þ34 93 7365085; fax: þ34 93 7365086. E-mail address: agarcia@mutuaterrassa.es (A. García Fernández). Contents lists available at SciVerse ScienceDirect The Breast journal homepage: www.elsevier.com/brst 0960-9776/$ e see front matter Ó 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.breast.2013.04.015 The Breast 22 (2013) 902e907