[The sentinel lymph node biopsy. Evolution and convalidation of the technique]

Sentinel node biopsy is a minimally invasive technique alternative to routine axillary dissection in breast cancer staging. This technique selects women with positive nodes who may benefit from axillary dissection, avoiding unnecessary operations in negative node biopsies.

In this article we report a 5 year multi disciplinary experience in sentinel node biopsy involving the General Surgery Unit of Imola Hospital in collaboration with Radiologist, Pathologists and Specialists in Nuclear Medicine.

From 2000 to 2004 the Authors treated 209 women performing 214 sentinel node biopsies (in 5 cases the tumor was bilateral). Sentinel node identification was undertaken by lymphoscintigraphy; in 15 cases we associated intradermal injection of blue dye. Lymph nodes were examined by at least 60 hematoxylin and eosin stained sections and when nodes found negative were further studied with immunohistochemical stains for cytokeratins.

Sentinel node identification rate was 99.1%. In 62 patients sentinel node was metastatic and in 17 such nodes micrometastases were detected. In 6 cases with single metastatic cells, axillary dissection was not perfomed, in accordance to current opinions. In 50 of 62 women with metastatic axillary nodes (80.6%) the sentinel node was the only metastatic one. Number of axillary dissections decreased of more than 70% in four years, from theoretical 214 to 62.

Sentinel node biopsy is currently a validated technique and many breast cancer patients are spared a regional lymph node dissection without compromising local control and the accuracy of staging.