Surmounting the challenges of sentinel lymph node biopsy for breast cancer in non-tertiary centres and...

Sentinel lymph node biopsy (SLNB), a procedure associated with low morbidity, has been shown to be an accurate technique for determining axillary lymph node status in breast cancer. It is now a standard of care in many tertiary oncology centres. The purpose of this study was to determine the feasibility of carrying out SLNB in non-tertiary centres and community practices without full nuclear medicine facilities and lower patient volume.

From November 2002 to February 2005, 50 women diagnosed with clinically node-negative breast cancer underwent 52 sentinel lymph node procedures. Surgery was carried out in five hospitals with different access to nuclear medicine facilities. Lymphatic mapping was therefore carried out with blue dye only. Patients were divided into two groups: group 1 comprised those with invasive disease who went on to have an axillary clearance, and group 2 comprised those who underwent SLNB only for a negative node. Routine pathological examination was carried out for sentinel nodes.

There were 31 SLNB with axillary dissection and 21 SLNB only. The identification rate was 96.2%. Among those who had concomitant axillary dissection, there were no false-negative results. The overall accuracy was 94%, sensitivity was 82% and specificity was 100%.

Consistent results in non-tertiary centres can be achieved with adequate attention to appropriate preceptorship and meticulous technique. Women who elect to have surgical treatment for breast cancer in these hospitals need not be denied the benefits of SLNB.