[Sentinel lymph-node assessment in breast carcinoma. Current status and future perspectives]

The sentinel-node technique was first introduced by Morton in high-risk melanoma of the skin. Recently, this technique has also been used in patients with T1 breast cancer. Lymphoscintigraphy and the gamma probe are currently used in sentinel lymph-node detection. Many investigators have used this technique in clinical practice and there is no standard procedure in terms of the timing of lymphoscintigraphy, type of vital stain, radiolabelled tracer, etc. This heterogeneity might account for the broad range of false-negatives reported in the literature. The aim of our study was to carefully review and analyse the literature in order to identify the most reliable technique for use in sentinel node detection. The results of the review seem to indicate that the simultaneous use of preoperative lymphoscintigraphy, intraoperative gamma probe and vital staining is capable of ensuring the best results. These data have been confirmed in our experience of 15 patients. The sentinel node search was successful in 100% of the cases, and the percentage of false negative was 0%. The use of the best technique available might prove extremely important, particularly in randomised clinical trials, comparing sentinel node biopsy with axillary dissection. In the patient group undergoing sentinel node biopsy, the axillary pathological staging is based exclusively on this technique and therefore its reliability must be assured if it is to serve as a precise guide in the planning of adjuvant treatments.