Sentinel lymph node biopsy in breast cancer. Recent experiences

Recent studies show the sentinel lymph node biopsy (SNB) as a reliable meth od for the determination of the nodal status in patients with breast cancer . We present our experience with this method during 3 years and discuss its potential and limitations. From 11/95 to 3/99 we performed a sentinel node detection in 146 patients with breast cancer stage I to III. We used the r aionuclide method including preoperative lymphscintigraphy and intraoperati ve gamma .probe detection. The detection rate varyed with the tumor size be tween 94 % for tumors with a diameter < 1 cm, 85 % (1-3 cm), 70 % (3-5 cm) and 63 % (> 5 cm). The accuracy of the SNB in the prediction of the nodal s tatus varyed also with the tumor diameter between 100 % for very small tumo rs (<1 cm), 97 % (1-3 cm), 88 % (3-5 cm) and 67 % (> 5 cm). In the subgroup of patients restricted to T1-2-tumors (n = 106), 57 patients (53 %) showed true negative, 4 (4 %) false negative SNB. 38 (36 %) revealed tumor cells in the HE-staining and an additional 7 patients (7 %) solely in the immunoh istochemical staining. The presented results show, that SNB is a reliable m ethod for the evaluation of the nodal status in early breast cancer patient s with a tumor size up to ca. 3 cm. While in about 50 % of these patients a surgical intervention could be avoided after a negative SNB, an additional 5-10 % of conventionally nodal negative patients can be found by the immun ohistochemical examination of the sentinel node. The sn-concept can also id entify parasternal metastasis and can be applied in patients after neoadjuv ant therapy and patients with recurrent tumor. Indications and contraindica tions of this method, however, still remain to be determined.