Sentinel node biopsy in breast cancer patients using blue dye guided lymphography

Purpose: Assessment of axillary nodal status with reduced shoulder-arm morb idity remains a major challenge for primary surgery of breast cancer patien ts. The rationale of the present study is the validation of sentinel-node b iopsy following blue-dye directed lymphography. Material and Methods: In a prospective study sentinel-node biopsy following peritumoural blue dye injection was performed in 92 breast cancer patients . The detection rate of the sentinel node, the sensitivity of the technique for the prediction of positive nodal status and the negative predictive va lue were assessed. Tumour-specific factors such as diameter and localisatio n were examined, together with the role of diagnostic or therapeutic measur es. Results: In 68/92 (73.9%) patients a sentinel node was identified. In small tumours there was a tendency to higher detection rates (T1 81.4%, T2 68.9% , T3/4 50%). Tumour localisation had no influence on sentinel node detectio n. The detection rate was significantly higher in two-stage procedures comp ared with one-stage procedures (25/27 vs. 43/65). The sensitivity of detect ing a positive nodal status was 87.0% for the whole group and 91.7% for T1 tumours. The negative predictive value was 93.8% for all patients and 95.6% for T1 tumours. In 95.6% of all patients and 97.7% of T1 cases, the nodal status was correctly predicted by sentinel node biopsy. Discussion: Sentinel node biopsy following blue-dye guided lymphography is a simple surgical technique that allows reliable identification of the firs t draining lymph node in breast cancer patients. As this technique implies high sensitivity in predicting a positive nodal status and a high negative predictive value, the procedure may in future prevent certain groups of pat ients from complete axillary clearing.