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Incidental lymphoma during sentinel lymph node biopsy for breast cancer.
Background: Sentinel lymph node biopsy (SLNB) is the recommended procedure for early stage breast cancer to identify nodal disease in the axilla. While metastatic adenocarcinoma is sought, the coexistence of lymphoma has been reported. This study was conducted to assess the frequency that lymphoma is diagnosed in the sentinel lymph node (SLN) for breast cancer staging. Methods: We conducted a retrospective chart review of patients seen and treated for breast cancer at a community-based surgical oncology practice from January 2006-June 2009 who underwent SLNB. Pertinent tumor data and patient information was collected. Results: 321 patients were included. All patients were female. Average age was 60.3 years. 320 SLNB was performed (1 attempted) with an average of 3.1 nodes obtained/procedure. Pathology results were: benign or reactive (226), metastatic breast cancer (67), micrometastasis (19), isolated tumor cells (8), and lymphoma (5). The average age of lymphoma patients was 68.2 years. None were previously diagnosed with lymphoma, leukemia, or had undergone radiation therapy. All patients had stage 0-IIA DCIS or IDC as their primary breast cancer without breast lymphoma. Small lymphocytic lymphoma (3), aggressive B- cell lymphoma (1), and low-grade B cell non-Hodgkins lymphoma (1) were the subtypes identified in the axillary node. One patient with metastatic breast cancer and lymphoma in the SLNs went on for completion axillary dissection without further nodes positive for metastatic breast cancer. One patient required chemotherapy for their lymphoma. To date, no patient has developed signs of recurrent breast cancer. Conclusions: While considered a rare finding, concurrent lymphoma was diagnosed in 1.6% of patients in this study. The clinical concern is that the finding of lymphoma in the SLN may prevent an accurate SLNB for breast cancer and therefore affect staging. Further prospective evaluation should be conducted to gain a better understanding of the true incidence and affect on staging in breast cancer.