The success rate of identification of the sentinel lymph node in breast cancer: Our training series

A new phase of breast conserving surgery has started very recently, aimed a t eliminating axillary dissection in node-negative patients by using the se ntinel lymph node (SN) technique. Between November 1998 and January 2000 we performed 151 operations for breast cancer on 145 patients. We performed a xillary lymphoscintigraphy using Tc-99-labeled human serum albumin microcol loidal particles injected subdermally in 50 patients who met our selection criteria. In this series we focused on the success rate of scintigraphic an d surgical sentinel node identification. The number of scintigraphic identi fications of the SN was 44 (88%), Only forty-three cases were evaluable, as in one case mapping showed an internal mammary hot node. All SNs were loca ted at the first level. After removal of the SN complete axillary dissectio n was performed. Eighteen patients (41.8%) had metastatic disease in the ax illa, There were five (11.6%) false negatives: two in T-2 tumors, one in a T-4 tumor and two in Tie tumors. We consider this series as our training se ries. Our results are similar to those reported in the literature. We belie ve that the most reasonable approach to SN biopsy is a two-step procedure: the ideal candidates are patients with T-1 cancer who can undergo the opera tion in an outpatient setting under local anesthesia and sedation. Complete axillary dissection is performed only if paraffin sections and immunohisto chemistry show metastatic disease.