Lessons Learned From 500 Cases of Lymphatic Mapping for Breast Cancer

Abstract

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.

Impact of non-axillary sentinel node biopsy on staging and treatment of breast cancer patients

“…Some of the technical aspects outlined above can explain the large differences in the reported incidence of non-axillary sentinel nodes (Uren et al, 1995;Roumen et al, 1997;Borgstein et al, 1998;Chatterjee et al, 1998;O'Hea et al, 1998;Reuhl et al, 1998;Rubio et al, 1998;Snider et al, 1998;Hill et al, 1999;Liberman et al, 1999;Miner et al, 1999;Imoto et al, 2000). Three studies concern results of biopsy of non-axillary sentinel nodes in a substantial number of patients Johnson et al, 2000;Zurrida et al, 2000).…”

Sentinel node micrometastasis in breast carcinoma may not be an indication for complete axillary dissection

“…While it is well documented that this technique accurately predicts axillary node status in over 90% of the cases, [1][2][3][4][5][6][7][8] there are many relevant clinical decisions and surgical practices that have not been completely standardized. These include: (a) immediate complete axillary dissection based on sentinel node status at intraoperative consult vs complete axillary dissection as part of a second surgical procedure; (b) clinical value of complete axillary dissection following sentinel node micrometastasis; [9][10][11] (c) clinical significance of tumor deposits less than 0.2 mm in size, detected either by hematoxylin and eosin (H&E), immunohistochemistry, or cytology alone; 12,13 (d) the best intraoperative consult detection method for metastatic disease (frozen section vs cytology); [14][15][16][17][18] (e) the definition of sentinel node micrometastatic disease at intraoperative consult; and (f) when to stop evaluating sentinel nodes in the presence of possible micrometastasis at intraoperative consult.…”

Radiation field design and regional control in sentinel lymph node‐positive breast cancer patients with omission of axillary dissection

“…20 In patients with positive SLNs, axillary dissection remained standard practice, despite the finding that the SLNs were the only involved lymph nodes in 40% to 60% of patients. [21][22][23][24][25][26][27] The rationale for completion axillary dissection was based on 2 assumptions: 1) the presence of tumor-containing SLNs signifies potential residual tumor in the remaining the axillary lymph nodes, and 2) these lymph nodes require removal to prevent progression to clinically manifest axillary recurrence. Invasive lobular 4 (13) 21 (13) 13 (20) 6 (15) 5 (25) Select studies of patients with positive SLN and who did not undergo ALND have demonstrated low regional recurrence rates in the setting of adjuvant systemic therapy and RT (Table 5).…”