Sentinel node biopsy in breast cancer - A minimal invasive procedure for staging of the axilla

Clinical examinations and imaging methods are not sufficiently reliable for an exact staging of axillary nodes in breast cancer. The sentinel node bio psy concept is a minimally invasive procedure to locate and remove the firs t and important nodes responsible for draining a tumor. Histologic examinat ions using immunohistochemical methods permit more accurate staging than he matoxylin and eosin staining alone. Between 4/1997 and 9/1998 a total of 62 patients with 65 breast cancers und erwent surgery. The sentinel node procedure with radio tracers and/or blue dye was performed in patients with clinically negative or unclear positive findings in the axilla, with a primary tumor size less than 5 cm; 11 patien ts had received preoperative chemotherapy. The sentinel node biopsy was fol lowed by axillary dissection in 44 cases. In 58 (89%) cases we found one or more ton an average 1.4) sentinel nodes w ith radio tracers tin 73%) and/or the blue dye method tin 85%). Axillary no dal status was correctly predicted in 43 of 44 (97.7%) cases; only in one p atient was the sentinel node false negative. After preoperative chemotherap y sentinel nodes were found in 9 cases; all of these were predictive. Micro metastases were found in two patients only after cytokeratine staining. Our results concur with the experience of other study groups in regard of s entinel node biopsy. The sentinel node concept is a fascinating method; its importance in breast cancer treatment appears to be comparable with introd uction of breast saving surgery in the 1980's.