SENTINEL NODE DETECTION IN BREAST-CANCER

The aim of sentinel node biopsy (SN) in breast cancer patients is to d etect the tumor-draining lymph node by means of isosulfan blue or Tc-9 9m labelled colloids. SN can be detected in 80 to 85 % of the patients , depending on the size of the tumor. Preoperative lymphoscintigraphy permits the draining nodes along the internal mammary artery also to b e visualized. The predictive value of the histological findings of SN for lymph nodes obtained from axillary dissection is about 95 %. Becau se of different diagnostic procedures using various radiotracers each center has to follow its own learning curve. To be sure that the nodal status derived from a SN procedure is of identical value to axillary dissection about 100 patients have to undergo sentinel node detection, followed by axillary dissection, and concordant results should be obt ained in 95 % of them at least. The SN, however, offers a chance of as sessing the lymph node at risk for metastasis by more detailed histolo gical procedures. Morbidity as a result of treatment for primary breas t cancer can be decreased if only patients suffering from metastatic d isease are subjected to axillary dissection. Currently, the indication criteria for a SN procedure should be restricted to small tumors (T1) with clinically uninvolved axillary status and patients with ductal c arcinoma in situ (DCIS).