LYMPHATIC MAPPING AND SENTINEL LYMPHADENECTOMY FOR BREAST-CANCER

Objective The authors report the feasibility and accuracy of intraoper ative lymphatic mapping with sentinel lymphadenectomy in patients with breast cancer. Summary Background Data Axillary lymph node dissection (ALND) for breast cancer generally is accepted for its staging and pr ognostic value, but the extent of dissection remains controversial. Bl ind lymph node sampling or level I dissection may miss some nodal meta stases, but ALND may result in lymphedema. In melanoma, intraoperative lymph node mapping with sentinel lymphadenectomy is an effective and minimally invasive alternative to ALND for identifying nodes containin g metastases. Methods One hundred seventy-four mapping procedures were performed using a vital dye injected at the primary breast cancer sit e. Axillary lymphatics were identified and followed to the first (''se ntinel'') node, which was selectively excised before ALND. Results Sen tinel nodes were identified in 114 of 174 (65.5%) procedures and accur ately predicted axillary nodal status in 109 of 114 (95.6%) cases. The re was a definite learning curve, and all false-negative sentinel node s occurred in the first part of the study; sentinel nodes identified i n the last 87 procedures were 100% predictive. In 16 of 42 (38.0%) cli nically negative/pathologically positive axillae, the sentinel node wa s the only tumor-involved lymph node identified. The anatomic location of the sentinel node was examined in the 54 most recent procedures; t en cases had only level II nodal metastases that could have been misse d by sampling or low (level I) axillary dissection. Conclusions This e xperience indicates that intraoperative lymphatic mapping can accurate ly identify the sentinel node-i.e., the axillary lymph node most likel y to contain breast cancer metastases-in some patients. The technique could enhance staging accuracy and, with further refinements and exper ience, might alter the role of ALND.