Sentinel lymphadenectomy for breast cancer: Experience with 180 consecutive patients: Efficacy of filtered technetium 99m sulphur colloid with overnight migration time

Background: Axillary node status remains the most important prognostic indi cator of survival in breast cancer patients. Only 25% to 35% of patients ha ving standard level I/II axillary dissection have involved nodes, yet all a ccept the potential for morbidity after the operation. This study was condu cted to assess whether status of the sentinel node(s) was an accurate predi ctor of the presence of metastatic disease in axillary or internal mammary nodes. Study Design: In 180 patients, technetium 99m sulphur colloid was injected in a 4-quadrant peritumoral distribution. During the first phase of the stu dy, 72 patients had sentinel node excision followed by a level I/II axillar y dissection. During the second phase of the study, 108 patients had sentin el node excision and only those with positive nodes had completion axillary dissection. Nodes were examined after formalin fixation by taking 10 secti ons at 20-mu m intervals and staining with hematoxylin-eosin. Results: Sentinel nodes were found in 162 (90%) of 180 patients. The mean n umber of sentinel nodes examined was 3.1. Of the 162 patients with successf ul lymphatic mapping, positive sentinel nodes were found in 44 (27%). In 23 (66%) of 35 patients with positive sentinel nodes who had a completion lev el I/II axillary dissection, the sentinel nodes were the only positive node s. The concurrent negative predictive value was 4% in the : first 72 patien ts who had completion axillary dissection after sentinel node excision, and 2% for the entire series. With evolution of technique, identification of s entinel nodes with radiolabeled colloid was successful in 97% of the last 1 00 patients. Conclusions: Because the concurrent negative predictive value was low, sent inel node excision appeared to accurately identify node status, potentially avoiding the need for standard level I/II axillary dissection in sentinel node-negative patients. (J Am Cell Surg 1999;188: 597-603. (C) 1999 by the American College of Surgeons).