title: Lymphatic mapping and sentinel node biopsy in the patient with breast cancer.
abstract: OBJECTIVE
  To identify the sentinel lymph node(s) (SLN[s]) (the first node[s] draining the primary tumor in the regional lymphatic basin) in patients with invasive breast cancer and to test the hypothesis that the histologic characteristics of the SLN predict the histologic characteristics of the remaining lymph nodes in the axilla.
  
  
  METHODS
  A prospective trial.
  
  
  METHODS
  Sixty-two patients with newly diagnosed invasive breast cancers.
  
  
  METHODS
  Patients underwent intraoperative lymphatic mapping using a combination of a vital blue dye and filtered technetium-labeled sulfur colloid. The SLN was identified and removed, followed by a definitive cancer operation, including a complete axillary node dissection.
  
  
  METHODS
  The metastatic distribution in the axilla was determined in patients with occult nodal disease.
  
  
  RESULTS
  The SLN was successfully identified in 57 (92%) of 62 patients using the 2 lymphatic mapping procedures. After localization, 18 patients (32%) were found to have metastatic disease, and the SLN tested positive in all 18 patients. There were no "skip" metastases, defined as an SLN that tested negative with higher nodes that tested positive. In 12 (67%) of 18 patients with metastatic disease, the SLN was the only site of disease. The metastatic distribution significantly favored SLN involvement. Among subjects with discordant nodal involvement, the probability of observing the distribution of SLN involvement by chance is very small (P<.001).
  
  
  CONCLUSIONS
  This study confirms that lymphatic mapping is technically possible in the patient with breast cancer and that the histologic characteristics of the SLN probably reflect the histologic characteristics of the rest of the axillary lymph nodes. The procedure also allows the pathologist to focus the histologic examination on 1 or 2 nodes, potentially increasing the yield of positive dissections and the accuracy of staging.
authors.affiliation: Comprehensive Breast Cancer Program, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa 33612-9497, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Albertini
authors.forename: G H
authors.initials: GH
authors.lastname: Lyman
authors.forename: C
authors.initials: C
authors.lastname: Cox
authors.forename: T
authors.initials: T
authors.lastname: Yeatman
authors.forename: L
authors.initials: L
authors.lastname: Balducci
authors.forename: N
authors.initials: N
authors.lastname: Ku
authors.forename: S
authors.initials: S
authors.lastname: Shivers
authors.forename: C
authors.initials: C
authors.lastname: Berman
authors.forename: K
authors.initials: K
authors.lastname: Wells
authors.forename: D
authors.initials: D
authors.lastname: Rapaport
authors.forename: A
authors.initials: A
authors.lastname: Shons
authors.forename: J
authors.initials: J
authors.lastname: Horton
authors.forename: H
authors.initials: H
authors.lastname: Greenberg
authors.forename: S
authors.initials: S
authors.lastname: Nicosia
authors.forename: R
authors.initials: R
authors.lastname: Clark
authors.forename: A
authors.initials: A
authors.lastname: Cantor
authors.forename: D S
authors.initials: DS
authors.lastname: Reintgen
mesh_terms: D001365:Axilla; D001706:Biopsy; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000601:surgery; D018275:Carcinoma, Lobular / Q000473:pathology / Q000601:surgery; D004396:Coloring Agents; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis / Q000473:pathology*; D011336:Probability; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013671:Technetium Tc 99m Sulfur Colloid
chemical_list: D004396:Coloring Agents; D013671:Technetium Tc 99m Sulfur Colloid