Learning sentinel node biopsy: Results of a prospective randomized trial of two techniques

Background. Evidence indicates that sentinel node (SN) biopsy can accuratel y predict axillary nodal status. Debate exists as to the optimal method of SN identification. Methods, Patients with clinical T1 or T2 tumors and negative axillae were r andomized to SN localization with blue dye (B) alone (n = 50) or blue dye p lus radioactivity (B+R) (n = 42). Patients undergoing needle localization ( n = 47) were assigned to blue dye. Results. The SN was identified in 110 patients (79%) and contained metastat es in 28. The SN predicted the axillary nodal statuts in 96 % of cases. The SN identification rate did not differ between B (88 %) or B+R (86 %) but t eas significantly lower in patients requiring localization (64 %). The ti,n e to SN identification also did not differ between B and B+R The number of cases done by an individual surgeon was a significant predictor of SN ident ification. A stepwise logistic regression analysis of factors influencing t he success of SN identification identified tumor location, needle localizat ion, number of operations, and body mass index as significant predictors. Conclusions, Our study does not identify any advantage for the use of the m ore expensive and complex method of SN identification using B+R compared wi th B alone, even for surgeons Learning the techniques.