Evaluation of feasibility and accuracy of sentinel node biopsy in early breast cancer

Background: Current literature has suggested that sentinel node biopsy may eventually replace axillary dissection as the nodal staging procedure of ch oice in early breast cancer. The goals of our study were to determine the a ccuracy of the sentinel node in predicting axillary nodal status and to eva luate the feasibility of incorporating sentinel node biopsy into a general surgical practice. Methods: Between June 1999 and August 2000, 158 clinically node negative wo men with a histological diagnosis of T1 or T2 breast cancer were enrolled i n the study. Both technetium sulfur colloid radiotracer and isosulfan blue dye were used to guide sentinel node biopsy. Sentinel node biopsy was alway s followed by a complete axillary dissection. The histopathology of sentine l nodes using serial sectioning and cytokeratin immunohistochemistry was co mpared with that of the nonsentinel nodes evaluated with routine hematoxyli n and eosin stain. Results: The overall sentinel node detection rate was 84% (89 of 106 patien ts). Sentinel node biopsy was most successful when a combination of radiotr acer and dye was used. The staging accuracy of sentinel node biopsy was 98% (87 of 89); the sensitivity of the method was 94% (34 of 36); the false ne gative rate was 6% (2 of 36); the negative predictive value was 96% (53 of 55); and the rate of metastases to the sentinel node only was 56% (20 of 36 ). The results varied considerably among surgeons. Conclusions: The findings in our study support the hypothesis that the sent inel node is an accurate predictor of axillary nodal status in women with e arly breast cancer. These results suggest that the excellent findings in th e literature can be reproduced by a group of general surgeons in a communit y-based hospital. (C) 2001 Excerpta Medica, Inc. All rights reserved.