The role of sentinel lymph node biopsy in women undergoing prophylactic mastectomy

BACKGROUND: Indications for prophylactic mastectomy (PM) range from LCIS to BRCA 1-2 positive, cosmesis, and cancer phobia. Occult cancels have been f ound in up to 5% of PM cases. Consequently, consideration must be given to the role of sentinel lymph node (SLN) biopsy as a diagnostic procedure in t hese patients as PM excludes the subsequent option of SLN biopsy. METHODS: From April 1994 to November 1999, all patients undergoing PM had S LN biopsy after four quadrant periaerolar injections of radiocolloid (450 m ci) and blue dye (5 cc). All patients were prospectively accrued to the com puterized database of breast patients. The SLN were all evaluated with hema toxylin and eosin (H&E) as well as CAM5.2 cytokeratin immunohistochemical ( CK-IHC) stains. RESULTS: Over a 67-month period, 1,356 patients were mapped; 57 patients un derwent PM in which 148 nodes (2.6 nodes per patient) were evaluated. Nodes were examined by routine H&E and CK-IHC staining. Two patients, neither of whom was found to have a cancer in the prophylactic mastectomy breast, wer e found to have a positive SLN by CK-IHC staining. infiltrating carcinoma w as discovered within the PM breasts of 2 additional patients. Sentinel lymp h node biopsy was negative for malignancy by H&E as well as CK-IHC stains. No lymphadema has been detected in PM patients. CONCLUSIONS: Sentinel node biopsy has been shown to be an accurate and mini mally invasive method of evaluating the lymphatic basin. This study shows t hat the absence of known disease within the breast does not preclude the pr esence of occult cancer or metastatic nodal disease. Four patients (7%) had a significant change in their surgical management as a direct result of se ntinel lymph node biopsy. Two patients were spared the complications of a c omplete axillary node dissection. This minimally Invasive procedure accurat ely evaluated the known disease status and provided new diagnostic informat ion. Most important, once a mastectomy is performed, the opportunity for SL N biopsy is lost should a cancer be found within the breast specimen. (C) 2 000 by Excerpta Medica, Inc.