Sentinel node mapping for breast cancer: the operative experience of a breast surgeon in a rural community

Sentinel lymph node biopsy has become an accepted procedure for staging the axilla in early stage breast cancer. Our objectives were to review our practice of sentinel lymph node (SLN) mapping in breast cancer, to determine the impact of frozen section (FS) analysis of the SLN on patient management, and to compare our results to national data. We retrospectively reviewed the medical records of our patients with breast cancer who underwent SLN mapping with or without axillary lymph node dissection (ALND) between 1999 and 2006. During this period, 478 patients were treated for breast cancer, with 227 patients undergoing SLN mapping. The SLN was identified in 201 patients, with a positive SLN found in 52 patients (25.9%). There was a discrepancy between the intraoperative analysis (FS/touch prep) and final pathology in 20 patients (11.3%). Nineteen of those patients had a negative FS with positive final pathology. Six of these patients underwent completion ALND. One patient had a false-positive FS with a negative ALND. No axillary recurrences were observed. Eight patients (3.5%) developed postoperative complications. Our practice has been to use intraoperative evaluation of the SLN to reduce the number of patients requiring a secondary ALND. In our study, six patients returned to the operating room for a completion ALND. Our complication rate and axillary recurrence rates were similar to national data.