Sentinel lymph node mapping for staging breast cancer: preliminary results of a prospective study

Axillary lymph node dissection is the gold standard for staging breast cancer, but it is associated with significant morbidity and complications. Sentinel lymph node mapping technique has demonstrated a successful detection of the node or nodes more likely to have metastasis. Two techniques are being used to detect sentinel lymph node-intraoperative use of gamma detecting probe after injection of radio tracer preoperatively and the injection of blue dye and lymphatic mapping intraoperatively. We used both techniques. Twenty-four patients underwent sentinel lymph node mapping. Blue dye and gamma detecting probe identified sentinel lymph nodes in 78% and 77% of patients, respectively. Overall, 23 of 24 patients had a sentinel lymph node identified (96%). Ten patients had metastatic disease in the axilla. Out of these ten patients the only positive node/nodes were the sentinel lymph node in six patients. The other four patients had positive non-sentinel lymph node along with positive sentinel lymph node. All of the patients who had metastatic disease in the axilla were detected by the sentinel lymph node mapping technique. Therefore, no patient had positive non-sentinel lymph node if the sentinel lymph node was negative. This technique was 100% predictive of the axillary status. Sentinel lymph node mapping technique will change the management of breast cancer and will allow two-thirds of the patients with breast cancer to be managed without axillary lymph node dissection with a resulting reduction in morbidity and cost.