Sentinel lymph-node biopsy qualification in breast cancer.
Lymphatic drainage from the breast is principally to the ipsilateral axilla. In patients with breast cancer the status of the nodes in the axilla is an important prognostic factor and can be used to determine local and systemic treatment. Clinical assessment of the node status is unreliable and imaging techniques, though promising, are at present not practical. The standard policy for management of the axilla is axillary clearance (either level II or III), which is justified by the fact that in both stages the armpit is treated. In those node-negative cases, however, it is an unnecessary operation and is linked to some morbidity. Various methods to obtain nodes for histologic evaluation in an attempt to stage the axilla have been tried. A pectoral node biopsy, where a single node is taken from the axillary tail, has been proven to be unreliable. A triple-node biopsy (pectoral, apical, internal mammary) provides excellent prognostic data but is difficult to perform in patients treated by breast conservation. Four-node sampling has been assessed in Edinburgh in two randomized trials comparing node sampling to level III axillary clearance. The four-node sampling technique was shown to be reliable for staging the axilla, and in node-negative cases no further treatment is required. Detailed morbidity has been evaluated in patients who underwent axillary dissection, and node sampling plus radiation and node sampling without radiation demonstrated that those with node sampling had the least morbidity. Those with radiation have reduced movement around the shoulder joint, and the axillary dissection group have increased swelling of the upper limb and slightly reduced abduction. Sentinel node biopsy is presently being evaluated in several centers by randomized studies. Several large series have shown the method to be accurate (98%) when the sentinel node is identified (about 90% of cases). Sentinel node biopsy should routinely enter the field of axilla surgery and thus patients without clinically recognized disease avoid overtreatment when the sentinel node is free of cancer.
Tamiolakis
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D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000628:therapy; D005188:False Negative Reactions; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D021701:Sentinel Lymph Node Biopsy / Q000379:methods