title: Prospective observational study of sentinel lymphadenectomy without further axillary dissection in patients with sentinel node-negative breast cancer.
abstract: OBJECTIVE
  Immediate complete axillary lymphadenectomy (ALND) after sentinel lymphadenectomy (SLND) has confirmed that tumor-negative sentinel nodes accurately predict tumor-free axillary nodes in breast cancer. Therefore, we hypothesized that SLND alone in patients with tumor-negative sentinel nodes would achieve axillary control, with minimal complications.
  
  
  METHODS
  Between October 1995 and July 1997, 133 consecutive women who had primary invasive breast tumors clinically </= 4 cm in diameter and no axillary lymphadenopathy were prospectively entered onto a trial of SLND using vital blue dye. Sentinel nodes were examined by standard microscopy or immunohistochemistry. SLND was the only axillary surgery if sentinel nodes were tumor-free. Completion ALND was performed only if sentinel nodes contained metastases or if they were not identified. Excluded from subsequent analysis were patients with unsuspected multifocal carcinoma and those who refused completion ALND. The complication and axillary recurrence rates after SLND without ALND were determined.
  
  
  RESULTS
  Sentinel nodes were identified in 132 (99%) of 133 patients. Eight patients were excluded from further analysis. Of the 125 assessable patients, 57 had tumor-positive sentinel nodes and one had an unsuccessful mapping procedure; these patients underwent completion ALND. In the remaining 67 patients (54%), SLND was the only axillary procedure. Complications occurred in 20 patients (35%) undergoing ALND after SLND but in only two patients (3%) undergoing SLND alone (P =.001). There were no local or axillary recurrences at a median follow-up of 39 months.
  
  
  CONCLUSIONS
  Complication rates are negligible after SLND alone. An absence of axillary recurrences supports SLND as an accurate staging alternative for breast cancer and suggests that routine ALND can be eliminated for patients with histopathologically negative sentinel nodes.
authors.affiliation: Joyce Eisenberg-Keefer Breast Center, Division of Surgical Oncology, Statistical Coordinating Unit, Department of Nuclear Medicine, Santa Monica, CA, USA. giulianoa@jwci.org
authors.forename: A E
authors.initials: AE
authors.lastname: Giuliano
authors.forename: P I
authors.initials: PI
authors.lastname: Haigh
authors.forename: M B
authors.initials: MB
authors.lastname: Brennan
authors.forename: N M
authors.initials: NM
authors.lastname: Hansen
authors.forename: M C
authors.initials: MC
authors.lastname: Kelley
authors.forename: W
authors.initials: W
authors.lastname: Ye
authors.forename: E C
authors.initials: EC
authors.lastname: Glass
authors.forename: R R
authors.initials: RR
authors.lastname: Turner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D011446:Prospective Studies; D012394:Rosaniline Dyes
chemical_list: D012394:Rosaniline Dyes; C025484:iso-sulfan blue