Intraoperative
Lymphatic Mapping & Sentinel Node Biopsy Predicts Axillary Nodal Involvement
and Avoids Negative Axillary Dissections in (N0) Breast Cancer
Tarek Ahmed Said, M.D
The Department
of Surgery, Cairo University
Kasr El Aini Journal of Surgery,
Vol (1), No (1),July 2000: 103-114
The status of the axillary nodes is
the strongest known prognostic factor variable in patients with breast
cancer, and is routinely used in planning postoperative therapy. Conventional
axillary dissection is limited by sampling error and potential morbidity.
With new wide scale regimens of screening and growing consensus of early
diagnosis of breast cancer, increasing numbers of negative axillary nodal
dissections are encountered. Sentinel node biopsy techniques have revolutionized
the management of axillary nodes. Accurate identification and focused histologic
evaluation of the sentinel node allow accurate prediction of the status
of the other axillary nodes, thereby avoiding the morbidity and expense
of a complete axillary dissection in node negative patients. In 26 cases
of breast cancer, SLN intraoperative mapping was done following preoperative
subcutaneous dye injection over breast mass. SLN detection success rate
was 76.92%. Pathological examination of detected SLN(s) and comparison
with the rest of axillary nodes revealed an accuracy rate of 90% in detection
of axillary status with a negative predictive value of 80%. With further
evaluation and growing experience with the technique, it can be a useful
method to decide when to proceed with formal axillary dissection in cases
with no clinically detected nodes.
