Sentinel node biopsy in breast cancer

The objective of this prospective study was to determine whether the sentinel node (SN) concept is appropriate in patients with breast cancer and whether it can be identified after peritumoral injection of Tc-99m nanocolloid using a hand held probe in the axillary drainage area. METHOD In 30 patients with Tl and T2 breast cancer lymphoscintigraphy was performed 2 and 18 h after peritumoral Tc-99m nanocolloid injection. Focal accumulations were registered and localized in vivo using a hand held gamma-probe. All patients underwent axillary lymph node dissection. From the surgical specimen the SN were identified ex vivo and were sent for pathological examination separately. RESULTS In all but two patients lymphoscintigraphy revealed at least one distinct focal accumulation (SN) in the axillary region. In nine women more than one SN was registered. In 28 patients the SN were identified in the surgical specimen. In this group, in 19 of 28 (67%), both the SN and the axillary lymph nodes were without metastasis. Three patients had metastasis both in SN and axillary lymph nodes ( 12%), and in six patients (21%) the SN was the only node with metastasis. CONCLUSION In the majority of breast cancer patients a SN can be identified in patients after peritumoral injection of Tc-99m colloid albumin. Using the hand held gamma-probe the SN were identified in the surgical specimen. So far the SN correctly predicts the axillary lymph node status.