A comparison of rates of lymph node metastases between patients undergoing sentinel and axillary lymphadenectomy.
BACKGROUND
Recommendations regarding credentialing for sentinel lymphadenectomy in the staging of breast cancer emphasize the need for a trial period during which novice surgeons remove both the sentinel lymph node and the axillary packet, to demonstrate acceptably low rates of both operative failure and inaccuracy.


METHODS
We initiated sentinel lymph node mapping in our institution without planned axillary dissection. To establish our ability to accurately stage patients using sentinel lymphadenectomy, we compared 225 patients who underwent that procedure and 343 patients previously staged with axillary lymph node dissection.


RESULTS
No differences in node positivity were found between the two groups. Among sentinel lymphadenectomy patients, no differences were found between patients in the first and second half of the institutional experience.


CONCLUSIONS
We question the need for a trial period of planned axillary node dissection with sentinel lymph node mapping, and review the evidence from other investigators regarding its necessity.
Moonka
Ravi
R
Department of Surgery, Virginia Mason Medical Center, C6-GSUR, 1100 Ninth Ave., P.O. Box 900, Seattle, WA 98111, USA.
Hunter
Jeffrey A
JA
Cray
William K
WK
Duncan
Mona
M
Wechter
Debra G
DG
D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D013502:General Surgery / Q000193:education / Q000592:standards; D006801:Humans; D016015:Logistic Models; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000601:surgery*; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy