Sentinel node biopsy or limited oriented axillary dissection (LOAD) in early breast cancer

The value of the sentinel node biopsy technique is recognised by the majority of surgical teams as an alternative to conventional axillary lymph node dissection for the treatment of small breast cancers. Secondary procedures are necessary when lymph node invasion not detected by frozen section examination is discovered post-operatively. In order to avoid or limit these reoperations, our sentinel node biopsy technique has gradually been transformed into limited oriented axillary dissection (LOAD), which avoids secondary procedures in the majority of patients.

Three hundred and eighty two patients were operated on by the same surgeon, using the patent blue sentinel node identification technique. This technique failed in nine patients, seven of whom were obese. Only one lymph node was removed in 75 patients, two in 88 patients, 3-5 in 174 patients and more than five lymph nodes were removed in the remaining patients. Eighty-eight percent of patients had no lymph node invasion on intraoperative and post-operative examination.

Only seven patients were reoperated by secondary conventional lymph node dissection and there was residual cancer in only one patient.

The oriented limited axillary dissection technique, combined with frozen section histological examination, avoids the usually unnecessary secondary operations in small breast cancers, in which axillary lymph node invasion rarely exceeds more than two nodes. This technique requires surgeons experienced in axillary surgery and conventional sentinel lymph node biopsy. It needs to be validated on a larger scale by a multicentre randomized prospective trial comparing LOAD to conventional axillary lymph node dissection.