Sentinel Lymph Node Technique for Staging of Breast Cancer

Lymphatic mapping and sentinel lymphadenectomy is becoming an important surgical technique for assessing axillary status in breast cancer. In experienced hands, it can be successfully performed in >90% of cases. The morbidity of sentinel lymphadenectomy is minimal, considerably less than the 15%-20% rate of complications associated with axillary lymph node dissection. Moreover, excision of the sentinel node provides a specimen for focused histopathologic analysis and experimental studies using sensitive immunohistochemical techniques and even reverse transcriptase polymerase chain reaction, which may improve detection of axillary metastases. Intraoperative mapping of the lymphatic tract draining to the sentinel node may use vital blue dye and/or radioactive tracer. The rate of sentinel node detection exceeds 90% with either agent alone or in combination. Because definitive follow-up data are not yet available, intraoperative lymphatic mapping and sentinel lymphadenectomy should be considered an experimental staging adjunct rather than a therapeutic modality.