Sentinel lymph node and breast cancer staging: Final results of the Turin multicenter study

Aim of the study: Validation of the sentinel node (SN) technique in breast cancer by means of lymphoscintigraphy. Materials and methods: From December 1996 to January 1999 102 T-1-T-2 breas t carcinoma cases were recruited in Turin, Tc-99m-human serum albumin collo ids were injected subdermally the day before surgery (mean activity, 5.2 +/ - 2.5 MBq). Scintigraphic imaging was performed after injection. After iden tification of the SN during surgery by a hand-held gamma probe, the SN was excised and sent for histologic examination. SN histology was compared with that of other axillary nodes. Results: The SN detection rate was 86.3%; among 88 cases with an identified SN, 37 (42%) had axillary metastases; the SN was metastatic in 35 cases (s ensitivity, 94.6%); in 51.3% of pN+ cases (19/37) the SN was the only metas tatic site. In two of the 53 negative SNs, SN histology did not match with that of the remaining axilla (negative predictive value, 96.2%; staging acc uracy, 97.7%), Conclusions: Our results agree with those reported in the literature; howev er, except in clinical trials and experienced structures axillary lymph nod e dissection should not be abandoned when mandatory for prognostic purposes , considering that at present SN biopsy alone is not completely accurate fo r axillary staging, especially in the absence of an adequate learning perio d.