Lymphatic mapping and sentinel lymph node biopsy in patients with breast cancer

The standard of care for the evaluation of axillary nodal involvement remai ns complete lymph node dissection. Lymphatic mapping and sentinel lymph nod e (SLN) biopsy are changing this long-held paradigm; indeed, several leadin g institutions already reserve complete axillary dissection for patients wi th metastasis to the SLN. In addition to reviewing the literature, this cha pter describes our lymphatic mapping experience at the H Lee Moffitt Cancer Center and Research Institute with 1147 breast cancer patients. Our result s, in addition to a meta-analysis of data from 12 institutions comprising a n additional 1842 patients undergoing complete axillary dissection, demonst rate that SLN biopsy is an accurate method of axillary staging. Although th e results from small series may exaggerate the probability of false negativ e results, the risk of nodal disease based on tumor size and other risk fac tors should be evaluated when considering the results of SLN sampling.