Selective analysis of the sentinel node in breast cancer

Background: This study was designed to determine the minimum number of sent inel nodes necessary to accurately stage patients with breast cancer. Methods: Between August 1997 and February 2001, 509 consecutive patients we re enrolled in a prospective sentinel node database. Nodes were characteriz ed as either blue or hot (>2 times background), or both, and ranked based o n the order harvested. Predictive value of the sentinel node based on these characteristics was evaluated to determine the minimum number necessary to stage the basin. Results: In all, 990 sentinel nodes were harvested from 465 basins. Patholo gic stage in 126 of 128 positive basins was predicted by the first or secon d node harvested. The remaining 2 patients were positive by immunohistochem istry only. The hottest node predicted the status in 114 of 128 basins. Conclusions: Although all nodes should be examined, these data suggest that limiting frozen section analysis to the first two sentinel nodes identifie d will not compromise the accuracy of staging and may provide a vehicle for resource savings. (C) 2001 Excerpta Medica, Inc. All rights reserved.