SENTINEL LYMPHADENECTOMY - AN ALTERNATIVE TO AXILLARY LYMPHADENECTOMYIN BREAST-CANCER

Background: Axillary lymph node status is an important determinant of prognosis in breast cancer. However, lymphadenectomy does not benefit half of the patients in whom axillary nodes are free of disease. Senti nel lymph node biopsy is a new technique which allows accurate staging of breast carcinoma without performing total axillary dissection. We describe our experience with the introduction of sentinel lymphadenect omy Methods: Thirty-seven sentinel lymphadenectomies were performed in 35 patients referred to the Department of Obstetrics and Gynaecology of the University of Berne between December 1997 and June 1998. Mappin g procedures were performed using a combination of vital blue dye with preoperative lymphscintigraphy with (99m)Technetium-labelled colloida l albumin and intraoperative use of a gamma probe. Complete axillary l ymphadenectomy was then performed in 34 patients. Results: One or more lymph nodes were identified in 33 of 37 procedures (89%). With the co mbination of both localisation techniques the sentinel nodes were iden tified in all(100%) of the last 19 patients. Sentinel and non-sentinel lymph nodes were always concordant. In this series the negative predi ctive value is 100% (95% confidence interval: 87.7%-100%). Metastases were found in the sentinel node in 11 of 30 patients (37%). From these 11 patients, 3 (27%) had micrometastases. Conclusions: Histopathologi c examination of the sentinel lymph node accurately predicts the axill ary lymph-node status. Patients with sentinel nodes free of metastases could avoid the unnecessary peri- and postoperative complications of complete axillary dissection. Further studies are needed to assess whe ther the improved diagnosis of micrometastases by sentinel lymphadenec tomy influences the long-term prognosis of breast cancer.