Because the tumor status of the regional lymph nodes is the most important
prognostic factor in patients with early-stage breast cancer, accurate hist
opathologic assessment of these nodes is essential for optimal management i
ncluding the selection of candidates for adjuvant systemic therapies. Intra
operative lymphatic mapping using a vital blue dye, with or without a radio
colloid, can identify the first axillary node to receive lymphatic drainage
from a primary breast carcinoma. Focused histopathologic assessment of thi
s sentinel node can be used to determine the tumor status of the entire axi
llary basin.
The minimal morbidity and high accuracy of sentinel lymph node dissection (
SLND) in breast cancer have been validated by multiple independent investig
ators, and the data suggest that this surgical technique may eventually rep
lace complete lymph node dissection as the preferred axillary procedure for
the management of early-stage disease. In experienced hands, SLND can be s
uccessfully performed in more than 90% of eligible breast cancer patients;
the tumor status of the sentinel node accurately predicts the status of all
axillary nodes in move than 95% of cases.
This article reviews the current status, controversies, and future directio
ns of SLND as a staging technique for patients with primary breast carcinom
a.