Intraoperative palpation increases the efficiency of sentinel lymph node biopsy but is not necessary for every operation

Background: Although intraoperative palpation (IOP) is recommended during the sentinel lymph node biopsy (SLNB), its actual effect on SLNB remains unclear. Meanwhile, controversy exists regarding whether IOP is necessary for all SLNB. The study examined the impacts of IOP on SLNB and determined whether IOP is necessary for every operation. Methods 126 patients with early stage breast cancer underwent SLNB using Indocyanine green (n = 64) and Methylene blue (n = 62). Traced lymph nodes (TLNs) were resected, followed by the palpated lymph nodes (PLNs) surrounding the original TLNs. and we analyzed the results (with and without IOP) in terms of detection rate, number of removed SLNs and detection rate of metastatic SLNs. Results Without IOP, the detection rates of the two group were 90.6%(58/64), 88.7%(55/62), but with IOP, all the rates increased to 100% (p < 0.05).The mean number also increased (With palpitation: Without palpitation = 3.5 : 2.9; 3.1 : 1.8, p < 0.05).73 (57.9%) patients were detected with PLNs and 13 (10.3%) were detected with only PLNs. In the 26 patients detected with metastatic nodes, 4 (15.4%) were detected with only palpated metastatic nodes. Conclusions Intraoperative palpation increases detection rate and number of SLNs and reduced the potential false-negative rate. But intraoperative palpation is not necessary for all SLNB when the number of TLNs reaches three or more.