[Sentinel node biopsy in breast cancer and primary tumor dimension]

Sentinel lymph node (SLN) biopsy, primary used as an alternative to elective lymph node dissection in melanoma, is being applied successfully in management of patients with breast cancer. The aim of this method in breast cancer is to determine the presence of axillary node involvement while clinically normal axilla. The validity of the sentinel node concept in breast cancer is demonstrated in various studies. The results of identification rates, sensitivity, overall accuracy and false negative rate are so encouraging in most publications, as to implement this concept to every-day surgical practice. There is lack, however, of many fundamental answers pertaining relationship between tumor-size and the results of SLN Biopsy or related surgical standards.

36 females at the age 33-66, with breast cancer underwent primary surgical treatment with SLN Biopsy in Department of Gynaecology and Oncology Jagiellonian University between 2001-2002. The study inclusion criteria were tumour size-T1, T2. The day before surgery the static scanning was performed after injection of Tc radiolabelled nannocolloid. SLN(s) were identified intraoperatively using a handheld gamma detection probe (Navigator GPS) and intraoperative lymphatic mapping with blue dye (Patent Blau V). After localization and excision of SLN(s), axillary's lymph node dissection (ALND) was performed.

In 34 patients SLN Biopsy revealed accumulation of the tracer in axilla, which was classified as SLN. Detection rate was 94.4% (34/36). Overall sensitivity of the procedure was 81%, whereas negative predictive value 92%. False negative rate was 2.2%. Detection rate for T1 tumors was 100% (15/15 cases), and for T2 tumors was 90.4% (19/21 cases). Sensitivity for tumor classified as T1 was 100% (3/3 cases), whereas for tumor T2 was 75% (6/8 cases).

SLN Biopsy seems to be very interesting alternative to ALND in patients with small tumor's dimension.