title: The hottest sentinel lymph node is not always the positive node.
abstract: The technique of identifying the sentinel lymph node (SLN) varies from each individual institution. Generally, the highest isotope count in a lymph node is considered the SLN, whereas other radioactive nodes might also be removed. The purpose of our study was to determine if the hottest node was always the tumor-containing node. Two hundred forty-seven breast cancer patients underwent SLN biopsy from April 1998 to April 2002. Lymphatic mapping involved a radiocolloid injection and lymphoscintigraphy followed by intraoperative assessment with a hand-held gamma probe. All SLN(s) with radioactive counts 10 per cent or more of the ex vivo counts of the most radioactive SLN were removed. The SLN were sliced at 2-mm intervals with 4-microm step-sections (92-microm spacing) and evaluated by microscopy and immunohistochemistry. One hundred twenty (49%) of the 247 patients had 2 or more nodes resected. Of these 120 patients, 33 (28%) had a tumor-bearing node. In 25 (74%) cases, the tumor-bearing node was the most radioactive; however, in 8 (26%) cases, the positive node was a lesser reactive node. Although the most radioactive node in a draining basin is considered the SLN, this is often not the metastatic node. Therefore, all nodes with significant radioactive counts must be removed to ensure accurate staging.
authors.affiliation: Department of Surgery, University of Florida, College of Medicine, Gainesville, Florida 32610, USA.
authors.forename: E R
authors.initials: ER
authors.lastname: Camp
authors.forename: J C
authors.initials: JC
authors.lastname: Cendan
authors.forename: R
authors.initials: R
authors.lastname: Feezor
authors.forename: D S
authors.initials: DS
authors.lastname: Lind
authors.forename: E
authors.initials: E
authors.lastname: Wilkinson
authors.forename: E M
authors.initials: EM
authors.lastname: Copeland
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology*; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D008297:Male; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals