Criteria for establishing the adequacy of a sentinel lymphadenectomy.
BACKGROUND
Criteria are needed that could be used to terminate a sentinel lymphadenectomy for breast cancer prior to removing every sentinel lymph node, without increasing false negative rates.


METHODS
Quantitative information on the radioactivity and color of sentinel lymph nodes removed from 541 breast cancer patients was correlated with pathologic information to determine when a sentinel lymphadenectomy could be terminated based on characteristics of the initially removed nodes.


RESULTS
Tumor was found in the first two sentinel lymph nodes removed in 127 of 129 node-positive patients. In 65% of patients who were able to be evaluated, the most radioactive lymph node was a positive lymph node. When any axillary lymph node was blue, then the first tumor-containing sentinel lymph node was also blue.


CONCLUSIONS
Removal of the most radioactive lymph node does not insure accurate assessment of the axilla. Removal of two sentinel lymph nodes accurately staged 98.4% of node-positive patients and 99.6% of the entire study population.
Duncan
Mona
M
Department of General, Vascular, and Thoracic Surgery, Virginia Mason Medical Center, C6-GSUR, PO Box 900, 1100 Ninth Ave., Seattle, WA 98111, USA.
Cech
Amy
A
Wechter
Debra
D
Moonka
Ravi
R
D001365:Axilla; D001706:Biopsy / Q000592:standards; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D003661:Decision Support Techniques; D019317:Evidence-Based Medicine; D005188:False Negative Reactions; D006801:Humans; D008408:Mastectomy; D009367:Neoplasm Staging / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic / Q000592:standards*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012394:Rosaniline Dyes; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D013671:Technetium Tc 99m Sulfur Colloid; D014861:Washington
D019275:Radiopharmaceuticals; D012394:Rosaniline Dyes; C025484:iso-sulfan blue; D013671:Technetium Tc 99m Sulfur Colloid