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The success rate of identification of the sentinel lymph node in breast cancer: our training series.
A new phase of breast conserving surgery has started very recently, aimed at eliminating axillary dissection in node-negative patients by using the sentinel lymph node (SN) technique. Between November 1998 and January 2000 we performed 151 operations for breast cancer on 145 patients. We performed axillary lymphoscintigraphy using 99Tc-labeled human serum albumin microcolloidal particles injected subdermally in 50 patients who met our selection criteria. In this series we focused on the success rate of scintigraphic and surgical sentinel node identification. The number of scintigraphic identifications of the SN was 44 (88%). Only forty-three cases were evaluable, as in one case mapping showed an internal mammary hot node. All SNs were located at the first level. After removal of the SN complete axillary dissection was performed. Eighteen patients (41.8%) had metastatic disease in the axilla. There were five (11.6%) false negatives: two in T2 tumors, one in a T4 tumor and two in T1c tumors. We consider this series as our training series. Our results are similar to those reported in the literature. We believe that the most reasonable approach to SN biopsy is a two-step procedure: the ideal candidates are patients with T1 cancer who can undergo the operation in an outpatient setting under local anesthesia and sedation. Complete axillary dissection is performed only if paraffin sections and immunohistochemistry show metastatic disease.
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