Sentinel lymph node involvement in T0T1 breast tumors.

Study aim: Determination of axillary lymph node status is crucial in diagno sis of early breast cancer. However thanks to an early diagnosis, an increa sing number of axillary lymph node dissections are free of disease. This ra ises questions about the need for this procedure. The study aim was to repo rt an experience with lymphadenectomy and sentinel node mapping in patients with T0-T1 carcinoma of the breast. Methods: Between November 1997 and December 1999, 84 consecutive women (T0- T1 NO according to the 1987 UICC classification) with recently diagnosed br east cancer, were included in this study for identification of the sentinel lymph node (SLN). The SLN was removed and submitted for histological exami nation. All patients underwent axillary dissection; nodes from levels I and II (Berg's classification) were excised and submitted to histological exam ination. Results: The average tumor diameter was 12,7 mm (range, 3 to 25 mm). The ly mphatic mapping technique was obtained after injection of the isotope into the breast around the tumor in 53/84 patients: the sentinel lymph node was the only positive node in 10 patients and it was positive in 5 patients wit h other axillary nodes. In 15/84 patients, an intradermal injection of blue dye was used; two sentinel nodes were positive and one falsely negative. I n 16/84 patients, an interdermal injection of blue dye was used to make up for. In this study, the sentinel node was positive in three patients and fa lsely negative in one patient. The discrepancy was due to an important invo lvement of an axillary area excluded from the lymphatic channels. 22/84 pat ients (26%) had a metastatic spread to the axillary nodes. 30/84 patients h ad also an isotopic captation in another lymph node group (internal mammary ). Conclusion: This study confirms that lymphatic mapping is technically possi ble in the patients with T0-T1 breast cancer and that the histological char acteristics of the sentinel node probably reflect the histological characte ristics of the rest of the axillary lymph nodes, but do not provide any inf ormation about the other lymph node sites. (C) 2001 Editions scientifiques et medicales Elsevier SAS.