IDENTIFICATION AND BIOPSY OF THE SENTINEL LYMPH-NODE IN BREAST-CANCER

Aims: To examine the hypothesis that lymphatic dissemination in breast cancer occurs sequentially. Methods: Thirty patients with clinically localized adenocarcinoma were studied. Patent blue dye was administere d into the tumour at the beginning of a modified radical mastectomy or segmental mastectomy with en bloc axillary lymph-node dissection (ALN D). In the removed specimen, blue-stained lymphatic channels were diss ected from the primary tumour to the first draining lymph node(s) (sen tinel node(s)). Results: Identification of a sentinel node (SN) was su ccessful in 26 patients (87%). In 10 patients the SN was tumour-positi ve. In six of these patients, the SN was the only tumour-positive node . There was no incidence of 'skip' metastasis. Conclusions: This study confirms the sequential nature of lymphatic dissemination. When confi rmed in vivo, these data may lead to a substantial reduction of the ne ed for ALND without compromising survival and regional control and wit hout loss bf prognostic and staging information.