Lymphatic mapping and sentinel lymphadenectomy in early stage breast carcinoma

The rate of axillary lymph node metastases is low in early stage breast car cinoma and axillary lymph node dissection is controversial in the treatment of these patients. Intraoperative lymphatic mapping technique is suggested for the identification of metastatic lymph nodes. Intraoperative lymphatic mapping was performed on 60 clinical stage I and II patients who were trea ted at Ankara Oncology Hospital between 1996-1998. Patent blue dye was inje cted in all cases, as the tumor was totally excised before mastectomy, into the surrounding breast tissue at four different quadrants. Presence of met astases were examined on stained lymph nodes (sentinel lymph node: SLN) by frozen-section. Modified radical mastectomy was performed including level I , II, III lymph node dissection. Metastases were evaluated on the remnants of frozen-section tissues and unstained lymph nodes (nonsentinel lymph node : nSLN) in axilla on hematoxyline-eosin stained slides and by immunohistoch emistry. Forty-nine (81.6%) SLNs were identified among 60 cases. In 18 (36. 7%) of these 49 patients, metastases were detected in SLNs by frozen sectio n. In one case micrometastasis was detected in the remnants of frozen-secti on by immunohistochemistry though it was negative with hematoxyline-eosin. There were no metastases in nSLNs of 27 cases whose SLNs's frozen-sections were tumor free. In 3 cases SLNs were negative but metastases were detected in nSLNs (false negative: 6.1%). There were no local or systemic complicat ions due to injections of dye. Selective lymph node dissections can be perf ormed on early stage breast cancer patients by means of lymphatic mapping. This minimally invasive technique identifies metastatic axillary lymph node s with a high degree of accuracy, so we can suggest that, non-metastatic pa tients can be treated without axillary dissection.