Sentinel Lymph Node Biopsy in Breast Cancer: Initial Experience at Memorial Sloan-Kettering Cancer Center

doi:10.1016/S1072-7515(98)00060-X

Journal of the American College of Surgeons

Volume 186, Issue 4, April 1998, Pages 423-427

https://doi.org/10.1016/S1072-7515(98)00060-X Get rights and content

Abstract

Background: Sentinel node biopsy (SNB) has emerged as a potential alternative to routine axillary dissection in clinically node-negative breast cancer.

Study Design: From September 1995 to June 1996 at Memorial Sloan-Kettering Cancer Center, 60 patients with clinically node-negative cancer underwent SNB, which was immediately followed by standard axillary dissection. Both blue dye and radioisotope were used to identify the sentinel node. SNB was compared with standard axillary dissection for its ability to accurately reflect the final pathologic status of the axillary nodes.

Results: The sentinel node was successfully identified by lymphoscintigraphy in 75% (42 of 56), by blue dye in 75% (44 of 59), by isotope in 88% (52 of 59), and by the combination of blue dye and isotope in 93% (55 of 59) of all 59 evaluable patients. Of the 55 patients in this study where sentinel nodes were identified, 20 (36%) were histologically positive. The sentinel node was falsely negative in three patients, yielding an accuracy of 95%. SNB was more accurate for T1 (98%) than for T2–T3 tumors (82%).

Conclusions: Lymphatic mapping is technically feasible, reliably identifies a sentinel node in most cases, and appears more accurate for T1 tumors than for larger lesions. Blue dye and radioisotope are complementary techniques, and the overall success of the procedure is maximized when the two are used together.

Section snippets

Patients and Methods

In a prospective study conducted from September 1996 to June 1997, 60 patients with clinical T1–3NO breast cancer had SNB at Memorial Sloan-Kettering Cancer Center. Informed consent approved by the institutional review board (IRB Protocol #96-049) was obtained before the procedure. All patients had biopsy-proved invasive cancer, but one patient was subsequently excluded when final pathologic review showed only ductal carcinoma in situ. Both mastectomy and breast conservation patients were

Results

Patient characteristics are detailed in Table 1. The mean patient age was 55 years. Thirty-five (59%) patients had a previous surgical biopsy. Preoperative lymphoscintigraphy was positive in 42 (75%) of 56 patients (Table 2), and most frequently imaged the axillary nodes.

The sentinel node was successfully identified by blue dye in 75% (44 of 59), by isotope in 88% (52 of 59), and by the combination of blue dye and isotope in 93% (55 of 59) of all 59 evaluable patients (Table 3).

Sentinel node

Discussion

Early breast cancer has a small but prognostically important rate of axillary nodal metastases. However, axillary dissection confers no benefit to the increasing fraction of patients with negative axillary nodes. In early breast cancer, SNB may allow accurate staging of the axilla and avoid the morbidity associated with a conventional dissection.

In Table 7 the results from this study are compared with those of previously reported series. Our success rate of lymphatic mapping with blue dye was

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¹: This work has been supported by grants from the Tow Foundation and the Liz Claiborne Foundation.

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Original ArticlesSentinel Lymph Node Biopsy in Breast Cancer: Initial Experience at Memorial Sloan-Kettering Cancer Center 1

Abstract

Section snippets

Patients and Methods

Results

Discussion

Surgical adjuvant chemotherapy in cancer of the breastresults of a decade of cooperative investigation

Ann Surg

Adjuvant cyclophosphamide, methotrexate, and fluorouracil in node-positive breast cancerthe results of 20 years of follow-up

N Engl J Med

Technical details of intraoperative lymphatic mapping for early stage melanoma

Arch Surg

Lymphatic mapping and sentinel lymphadenectomy for breast cancer

Ann Surg

Original Articles
Sentinel Lymph Node Biopsy in Breast Cancer: Initial Experience at Memorial Sloan-Kettering Cancer Center ¹