Sentinel lymph node biopsy for breast cancer: A suitable alternative to routine axillary dissection in multi-institutional practice when optimal technique is used

Purpose: Previous studies have demonstrated the feasibility of sentinel lym ph node (SLN) biopsy for nodal staging of patients with breast cancer. Howe ver, unacceptably high false-negative rates have been reported in several s tudies, raising doubt about the applicability of this technique in widespre ad surgical practice. Controversy persists regarding the optimal technique for correctly identifying the SLN. Some investigators advocate SLN biopsy u sing injection of a vital blue dye, others recommend radioactive colloid, a nd still others recommend the use of both agents together. Patients and Methods: A total of 86 patients were enrolled by 99 surgeons. SLN biopsy was performed by single-agent (blue dye alone or radioactive col loid alone) or dual-agent injection at the discretion of the operating surg eon. All patients underwent attempted SLN biopsy followed by completion lev el I/II axillary lymph node dissection to determine the false-negative rate . Results: There was no significant difference (86% v 90%) in the SLN identif ication rate among patients who underwent single- versus dual-agent injecti on. The false-negative rates were 11.8% and 5.8% for single-versus dual-age nt injection, respectively (P <.05). Dual-agent injection resulted in a gre ater mean number of SLNs identified per patient (2.1 v1.5; P <.0001). The S LN identification rate was significantly less for patients older than 50 ye ars as compared with that of younger patients (87.6% v 92.6%; P =.03). Uppe r-outer quadrant tumor location was associated with an increased likelihood of a false-negative result compared with all other locations (11.2% v 3.9% ; P <.05). Conclusion: In multi-institutional practice, SLN biopsy using dual-agent in jection provides optimal sensitivity for detection of nodal metastases. The acceptable SLN identification and false-negative rates associated with the dual-agent injection technique indicate that this procedure is a suitable alternative to routine axillary dissection across a wide spectrum of surgic al practice and hospital environments. J Clin Oncol 18:2560-2566. (C) 2000 by American Society of Clinical Oncology.