Sentinel lymph node biopsy for staging breast cancer

BACKGROUND: Determination of axillary nodal status is essential for the sta ging of breast cancer since nodal status is one of the most important predi ctors of survival. The objective of this study was to test the hypothesis t hat the histology of the first draining lymph node (LN) accurately predicts the histology of the rest of the axillary LNs. METHODS: Fifty-five patients with operable invasive breast carcinoma and cl inically negative axillary lymph nodes were studied. Patients were injected with Technetium-(99) (Tc-99) sulfur colloid around the primary tumor. A ha nd-held gamma detector probe was used to identify the sentinel LN (SLN). Af ter the SLN was identified and removed, a level I and II lymphadenectomy wa s performed. RESULTS: The SLN was identified in 53 (96.3%) of the 55 patients entered in to the trial. The sensitivity was 88.2% and the specificity was 100%. The p ositive predictive value was 100% and the negative predictive value was 94. 6%. The accuracy of the study was 96.2%. CONCLUSIONS: The SLN biopsy for breast cancer staging is highly accurate in our hands and has the potential to decrease the morbidity and cost of mana ging patients with breast cancer without compromise of staging. Am J Surg. 1998;176: 532-537. (C) 1998 by Excerpta Medica, Inc.