Sentinel lymph node biopsy, an alternative to elective axillary dissectionfor breast cancer

BACKGROUND: Axillary metastases remain an important prognostic indicator in breast cancer. Axillary lymphadenectomy (ALND) carries significant morbidi ty and is unnecessary in most patients with early breast cancer; thus, sent inel lymph node (SLN) biopsy has been advocated for axillary staging. We st udied the SLN identification rate and its accuracy in predicting axillary m etastases, METHODS: One hundred nineteen women with breast carcinoma underwent SLN and ALND. Lymphoscintigraphy was performed using Technetium(99) sulfur colloid supplemented by Isosulfan blue dye. Hematoxylin/eosin-stained lymph node s ections were examined by light microscopy. RESULTS: The SLN identification rate was 81%, One SLN was negative (1%) in a patient with axillary disease. SLN histology correctly predicted the abse nce of axillary disease in 98.6%, Sensitivity, specificity, and positive an d negative predictive values were 96%, 100%, 100%, and 99%, respectively, CONCLUSIONS: Sentinel lymph node biopsy accurately predicts total axillary status and is valuable in the surgical staging of breast cancer. Am J Surg, 1998;176:529-531. (C) 1998 by Excerpta Medica, Inc.