Positive non-sentinel lymph nodes in breast cancer.

To the Editor—We thank Professor Ng for her constructive comments on our paper in her article “The role of pathology and pathologists in the detection and management of cancer”.1 Ng pointed out that it would be useful to know the number of patients with positive sentinel lymph node (SLN) who went on to have positive non-SLN in the axillary dissection. We present below a breakdown of the status of non-SLN in all patients with positive SLN (Table). In our series,2 there were 74 patients with positive SLN, 70 of whom underwent axillary dissection. The presence of isolated tumour cells was considered clinically insignificant (N0 in pTNM classification) in our protocol, so all but one of the patients in this category did not undergo axillary dissection. Intra-operative assessment of SLN is more commonly practised in the private sector, because cost to patients is a major consideration.