Accuracy of sentinel node biopsy in predicting nodal status in patients with breast carcinoma

Background and Objectives: While sentinel lymph node biopsy is considered b y many to have replaced axillary node dissection in the management of breas t cancer, concerns remain regarding false-negative results. Methods: To investigate the accuracy of sentinel node biopsy, we reexamined all sentinel and nonsentinel nodes with multilevel sectioning and immunohi stochemical staining in 42 consecutive cases of breast cancer in which sent inel node biopsy was performed and followed by axillary dissection. Results: By routine hematoxylin and eosin (H&E) staining, 34% of patients w ere found to be node positive, with no cases of false-negative sentinel nod e biopsy. Reevaluation of 775 negative sentinel and nonsentinel nodes with an additional two levels and immunohistochemistry identified three "node-ne gative" patients who had micrometastases in the sentinel node, increasing d etection in 8% of cases. More important, is the fact however, that there we re no cases where additional sections and immunohistochemistry identified m etastases in nonsentinel nodes that had bypassed the sentinel node. The acc uracy of the sentinel node in predicting the nodal status was 100%. Conclusions: Cytokeratin immunohistochemistry will identify more patients w ith nodal micrometastases; however, it was unable to identify any cases whe re micrometastases were present in nonsentinel nodes when the sentinel node was negative. The status of the sentinel node accurately identifies the st atus of the axillary basin. J. Surg. Oncol. 2001;77:243-246. (C) 2001 Wiley -Liss, Inc.