Lymphatic mapping with sentinel lymph node biopsy in patients with breast cancers < 1 centimeter (T-1(A)-T-1(B))

Because of its high cost and attendant morbidity, the necessity of axillary dissection in patients with small invasive primary tumors has been questio ned. Lymphatic mapping with sentinel lymph node (SLN) biopsy is an alternat ive to complete axillary dissection; however, researchers have excluded pat ients with T-1A-T-1B lesions. Seven hundred patients with newly diagnosed b reast cancers underwent an Institutional Review Board-approved prospective trial of intraoperative lymphatic mapping using a combination of Lymphazuri n and filtered technetium-labeled sulfur colloid. An SLN was defined as a b lue node and/or hot node with a 10:1 ex vivo radioactivity ratio in:the SLN verus non-SLNs. All SLNs were evaluated by both hematoxylin and eosin and cytokeratin immunohistochemical stains. Of the 700 patients, 665 (95.0%) we re mapped successfully. One hundred ninety-six (28.0%) had T-1A-T-1B tumors . Forty patients (20.4%) with T-1A-T-1B tumors had metastases to the SLNs. We conclude that breast cancer SLN mapping is highly accurate and sensitive when combined dye techniques (radiocolloid and vital blue dye) are utilize d. This technique is particularly useful in patients with small invasive pr imary tumors, which, despite their size, still demonstrate a significant ra te of axillary metastasis. These patients should not be excluded from lymph atic mapping protocols.