The anterior sentinel lymph node biopsy (SLNB) can accurately assess the pathological status of axillary lymph nodes, and can be a safe and effective alternative to axillary lymph node dissection (ALND) for patients with clinical axillary lymph node negative breast cancer, thus significantly reducing surgical complications. False negative refers to the situation that SLN does not find tumor involvement but axillary lymph nodes have metastases, which affects the choice of surgical modality and treatment effect. SLNB is suitable for patients with stage T1-2 breast cancer, and with the continuous research on SLNB for breast cancer, more and more relative contraindications are gradually transformed into indications. In addition, neoadjuvant chemotherapy can destroy the structure of the lymphatic network, so that the localized SLN is not the real SLN, and the metastasis in the SLN may disappear after chemotherapy, making the false-negative rate increase. 2. False negatives associated with SLN localization The intraoperative determination of SLN varies according to the tracer, and the preferred recommendation is to use a combination of blue dye and nuclear tracer, which can increase the success rate of SLNB and decrease the false-negative rate. acosog
The false-negative rate of Z1071 using blue dye combined with nuclear method is 10.8%, which is lower than 20.3% when using blue dye method alone, fluorescence detection method is the latest rapid and safe detection method can quickly find the anterior lymph nodes and imaging on the monitor, the disadvantage is that the equipment system is more expensive, the false-negative rate of the new localization method is about 5%, the combination of fluorescent material and nanomaterial can further reduce the false-negative rate. The combination of fluorescent materials and nanomaterials can further reduce the false negative rate. False negatives related to pathology Frozen rapid pathological histology and/or print cytology is recommended as an intraoperative diagnostic test for SLN. A positive diagnosis of both or either intraoperative frozen pathology and print cytology is considered positive for SLN. Intraoperative molecular diagnostic techniques have higher accuracy and sensitivity than frozen rapid pathological histology and print cytology because of the greater amount of SLN tissue detected. 4, other factors: including the number of SLN sampling (it is generally believed that the false negative rate decreases when 3 or more lymph nodes are removed. When the number of SLN sampling reaches 5, more than 99% of positive SLN can be found); the influence of jumping metastasis; the metastasis of SLN in the internal breast area; the influence of the surgeon’s operating experience, etc. Accurate SLN diagnosis can guide the choice of surgical modality and avoid the cost burden and surgical risk of secondary surgery, and each influencing factor should be controlled in clinical work to reduce the false-negative rate.