Authors Address

Nilesh A. Patel, MD and Thomas Julian, MD Allegheny General Hospital 320 East North Avenue Pittsburgh, PA 15214

Abstract

Sentinel node biopsy (SNB) is quickly developing into a possible alternative to axillary node dissection (AND) for breast cancer. Multiple studies have explored the technical aspects of this approach; however, few have attempted to critically identify patient and tumor related factors that limit SNB. Studies to this effect have been limited by sample size and surgeon variability. The present study attempts to enumerate these limitations in a unique group of patients.

One hundred thirty SNB performed by a single surgeon between May 1997 and June 2001 were reviewed. Of these, one hundred eleven patients had both SNB and AND . Thirty-eight patients had undergone prior segmental mastectomy and 31 patients received neoadjuvant therapy.

Overall, SNB was successful in 96% of patients with a 97% correlation with the AND. Sentinel node identification was not affected by age or tumor size. SNB was successful in all patients with neoadjuvant therapy or prior segmental resection. No false negatives were noted in the neoadjuvant group. Location of the tumor in the upper outer quadrant significantly decreased the ability identify the sentinel node (p=O.05). Ninety-seven percent of positive SNB were identified using both gamma counter and blue dye as comparec to only 74% using blue dye alone.

SNB is a highly accurate method to identify axillary metastases. This technique is not limited by age, tumor size, prior segmental resection or neoadjuvant therapy. SNB detection by both isotope and blue dye is superior to blue dye alone. Location of the tumor in the upper outer quadrant significantly affects sentinel node identification.



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