Minimal invasive staging for breast cancer: clinical experience with sentinel lymph node biopsy

During the 1990s, considerable research and development resulted in reasonably reliable methods to target the set of lymph nodes most likely to contain metastases in patients with breast cancer. The methods of identification of these "sentinel nodes" (SNs) involve injection of a visual-based dye or a radioactive tracer. The tracer/dye enters the lymphatics and labels the SNs so that they can be selectively removed. SNs can be successfully identified in > or =90% of patients. In breast cancer patients with clinically negative lymph nodes, the accuracy of the SNs to predict whether any nodal metastases are present is > or =97%. The false-negative rate, however, ranges from 0% (in smaller series) to 11%. Clinical trials are in progress that will determine the long-term safety and predictive value of SN resection in patients with breast cancer. Successful application of SN surgery should allow elimination of conventional axillary lymphadenectomy in at least 75% of patients with breast cancer. Semin Oncol 28:229-235.