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ObjectiveTo evaluate the factors affecting the identification and accuracy of the sentinel node in breast cancer in a single institutional experience. Summary Background DataFew of the many published feasibility studies of lymphatic mapping for breast cancer have adequate numbers to assess in detail the factors affecting failed and falsely negative mapping procedures. MethodsFive hundred consecutive sentinel lymph node biopsies were performed using isosulfan blue dye and technetium-labeled sulfur colloid. A planned conventional axillary dissection was performed in 104 cases. ResultsSentinel nodes were identified in 458 of 492 (92%) ConclusionsSentinel node biopsy in patients with early breast cancer is a safe and effective alternative to routine axillary dissection for patients with negative nodes. Because of a small but definite rate of false-negative results, this procedure is most valuable in patients with a low risk of axillary nodal metastases. Both blue dye and radioisotope should be used to maximize the yield and accuracy of successful localizations.The histologic status of the axillary nodes remains the single best predictor of survival in patients with breast cancer.' The sentinel node is defined as the first lymph node in a regional lymphatic basin that receives lymph flow from a primary tumor. Several investigators have confirmed the hypothesis that lymphatic drainage of a breast cancer can be identified and traced to the sentinel node during surgery, and that the histologic status of the sentinel node accurately predicts the pathologic status of the entire axilla.8 The aim of this study was to evaluate in detail a single institutional experience in establishing and developing lymphatic mapping for breast cancer. Particular focus was on unsuccessful mapping procedures, the relative value of blue dye and radioisotope in localizing the sentinel node, false-negative results, and patients with positive nodal disease.

The N6 approach reliably achieves significant cytoreduction against stage 4 neuroblastoma. This may eventuate in an improved cure rate, since consolidative treatments using myeloablative therapy, immunotherapy, or biologic response modifiers such as cis-retinoic acid are most likely to be effective against minimal residual disease.

The dermal and parenchymal lymphatics of the breast drain to the same SLN in most patients. Because ID injection is easier to perform and more effective, this technique may simplify and optimize SLN localization.

The five variables associated with successful SLN localization by blue dye or by isotope overlap but are not identical. Only three of these, intradermal isotope injection, a positive LSG, and age < 60, predicted success by the dye-isotope combination in the multivariate model. Dye and isotope complement each other, and SLN biopsy for breast cancer should use both.