SENTINEL NODE BIOPSY IN THE STAGING OF BREAST-CANCER

BACKGROUND: The role of axillary lymph node dissection (ALND) in breas t cancer is currently being reevaluated. Sentinel node biopsy (SNB) ho lds promise for replacing full dissection in a large number of patient s with breast cancer. MATERIALS: We evaluated SNB utilizing an intraop erative gamma probe localization technique following injection of tech netium sulfur colloid in 80 patients with primary breast cancer and cl inically negative axillae. Forty-eight patients were evaluated at Bapt ist Medical Center, Montgomery, Alabama, and 32 at Rush-Presbyterian-S t. Luke's Medical Center in Chicago, Illinois. RESULTS: At least one s entinel node was found in 70 of the 80 patients (88%). One patient had a sentinel node in both the axilla and internal mammary chain. The re mainder had axillary sentinel nodes only. The sentinel nodes accuratel y predicted the status of the axilla in 69 of the 70 patients (99%). O ne of 14 node-positive patients would have been missed with sentinel n ode biopsy alone, for a false negative rate of 7%. Four node-positive patients would have been missed with routine ALND without serial secti oning (SS) and immunohistochemical staining (IH) of the sentinel node. CONCLUSIONS: Sentinel node biopsy with SS and IH more precisely predi cted the status of the axilla than routine ALND in this group of patie nts. SNB will likely replace full axillary dissection in the majority of patients with breast cancer. (C) 1998 by Excerpta Medica, Inc.