Sentinel node biopsy in breast cancer and melanoma requires adequate self-audit

Sentinel node biopsy (SNB) is an evolving technique with potential for improving staging. Melanoma and breast cancer are the two most commonly used applications. The present study relates the author's validation data in both diseases.

Review of a prospective database.

Between January 2000 and December 2001 92 cases of breast cancer were offered SNB. The first 48 had completion axillary dissection. The identification rate was 92%. There were 28 true negative, 15 true positive and one false negative case. A mean of 2.0 nodes were removed (range 1-4). Completion axillary dissection removed a mean of 15.1 nodes. The following 44 cases were offered a choice of SNB alone, axillary dissection or a combination of techniques. Thirty-seven women chose SNB alone. There was one technical failure, 28 negative SNB and eight positive SNB results. A mean of 3.1 lymph nodes were removed (range 1-9) applying a 10% rule. At 24-36 months follow up there have been no cases of locoregional recurrence. From January to December 2001 36 cases of melanoma > or =1 mm were managed with SNB. Twenty-eight SNB were negative and eight were positive (22%). At follow up (range 12-24 months) there were three locoregional recurrences, but only one of these were in the node basin determined to be previously negative by SNB (3.5%).

Sentinel node biopsy in breast cancer is a valid alternative to full axillary dissection for staging the axilla. Patients can make an informed choice to have SNB alone if they understand the limitations of the technique and possible consequences of these limitations. In melanoma SNB provides valuable prognostic information most melanoma patients prefer to have. Adequate self-audit is necessary before a patient can make an informed decision to have SNB in either disease.