SENTINEL AXILLARY LYMPHADENECTOMY WITH INTRAOPERATIVE LYMPHATIC MAPPING IN BREAST-CANCER

Lymphatic mapping and sentinel lymphadenectomy have been shown to prov ide highly accurate staging with extremely low morbidity in malignant melanoma. This report describes an investigation of this minimally inv asive technique for axillary sentinel node identification in 51 consec utive breast carcinomas treated by radical or segmental mastectomy bet ween January and July 1996. A blue-stained sentinel lymph node was fou nd in 39 (76.5%) of 51 procedures and identified axillary nodal status in 36 (92.3%) of 39 patients. The rate of metastatic spread to the se ntinel lymph node was 41% (16/39). Eight of these 16 patients had no o ther involved axillary nodes. Among the 12 women in whom sentinel node s were not identified, 7 (58%) had no histologic evidence of axillary metastasis. The detection of occult metastasis or micrometastasis has been improved by a cytokeratin immunohistochemical technique performed on selected blue-stained lymph nodes. Further indications for and ext ension of axillary dissection, especially in the early stages of breas t cancer, will be influenced by the results of ongoing studies of sele ctive lymphadenectomy involving both lymphatic mapping with blue dye a nd injection of radionuclide tracer.