Potential and pitfalls of sentinel node detection in breast cancer.
The last decade has seen the development of a minimally invasive technique to identify representative nodes--sentinel nodes--that reflect the tumor status of nodes in the axillary lymphatic basin draining a primary breast carcinoma. Sentinel lymph node dissection (SLND), originally developed as an alternative to elective complete lymph node dissection in patients with primary cutaneous melanoma, has been applied successfully to the management of patients with breast cancer. SLND holds promise as a staging technique to replace formal level I and II axillary lymph node dissection in selected patients with breast carcinoma, thus avoiding an unnecessary procedure that has no role in many patients with tumor-free axillae. Under way are two large randomized trials examining the role of SLND for the management of patients with invasive breast carcinoma. Even when tumor is detected in the sentinel node, a focused examination of this node may indicate whether or not completion axillary lymph node dissection is necessary. However, although SLND has great potential, its successful widespread use requires more stringent definition of the sentinel node and standardized guidelines for lymphatic mapping. Each institution must carefully assess the accuracy and consistency of results obtained by its multidisciplinary SLND team.
Chu
K U
KU
John Wayne Cancer Institute, Santa Monica, CA 90404, USA.
Giuliano
A E
AE
D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D004396:Coloring Agents; D005188:False Negative Reactions; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D015337:Multicenter Studies as Topic; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011786:Quality Control; D011877:Radionuclide Imaging / Q000295:instrumentation; D019275:Radiopharmaceuticals; D016032:Randomized Controlled Trials as Topic; D012394:Rosaniline Dyes; D021701:Sentinel Lymph Node Biopsy; D013668:Technetium Tc 99m Aggregated Albumin; D013671:Technetium Tc 99m Sulfur Colloid
D004396:Coloring Agents; D019275:Radiopharmaceuticals; D012394:Rosaniline Dyes; D013668:Technetium Tc 99m Aggregated Albumin; C025484:iso-sulfan blue; D013671:Technetium Tc 99m Sulfur Colloid