Survival outcomes of early-stage breast cancer patients who underwent breast conservative surgery based on sentinel lymph node biopsy method: A retrospective cohort study

Background The implementation of sentinel lymph node biopsy (SLNB) with permanent section (PS) analysis alone in patients who satisfied the ACOSOG Z0011 criteria did not alter the standard of care offered by the additional frozen section (FS) analysis. This retrospective study reports the patient survival outcomes of early-stage breast cancer based on sentinel lymph node biopsy techniques. Methods Our previous investigation examined 453 SLNB cases at King Chulalongkorn Memorial Hospital, with follow-up concluding on April 15, 2025. The study included patients diagnosed with clinically node-negative primary invasive breast cancer, who underwent breast-conserving surgery. The primary endpoint was 5-year disease-free survival (DFS), while secondary outcomes encompassed the overall cumulative incidence of local, distant, and axillary recurrence, as well as overall survival (OS). Results Of the 453 patients with SLNB, 239 underwent SLNB with PS alone, while 214 received additional FS. The 5-year DFS was 95.8% in the PS group and 93.5% in the FS group ( P  = 0.263). The overall survival (0.596) was similar between FS group and PS group. In the PS group, local and distant recurrence rates were 1.3% and 2.5%, respectively, with no observed regional recurrences. Conclusion Based on the DFS and OS outcomes from our 5-year follow-up data, SLNB with PS analysis alone in patients meeting the ACOSOG Z0011 criteria was found to be non-inferior to SLNB with FS analysis.