title: Is there any benefit from sentinel lymph node biopsy using the combined radioisotope/dye technique in breast cancer patients with clinically negative axilla?
abstract: OBJECTIVE
  We evaluated the eventual benefits from sentinel lymph node biopsy (SLNB) in comparison with axillary lymph node dissection (ALND) using a combined radioisotope/dye technique versus dye alone in breast cancer patients.
  
  
  METHODS
  SLNB was performed in 501 breast cancer patients (250 patients with dye alone and 251 with combined technique). Patients were divided in three groups: (A) clinical stage T1,2N0 (SLNB followed by ALND only in cases with positive histology), (B) clinical stage T1,2N0 (SLNB followed by ALND), and (C): advanced clinical stage (SLNB immediately followed by ALND). The incidence of recurrences and surgery morbidity was comparatively evaluated.
  
  
  RESULTS
  The overall successful identification rate in patients of groups A and B was 97.7% (95.3% with dye and 99.3% with dye and isotope, P = 0.04) and in patients of group C 96.1% (93.3% with dye and 1000% with the combined technique, P = 0.02). The false-negative rate did not reach statistical significance between groups. Although locoregional recurrence rate was similar in groups A and B (less than 1.88%) the distant metastasis rate was significantly lower in group A (0.9 vs. 6.6%, P = 0.04). Arm edema was significantly more frequent in group B (0 vs. 5.3%, P = 0.02).
  
  
  CONCLUSIONS
  The combined technique, improves the ID rate of SLNs in patients with breast cancer. The recurrence rate in the axilla was negligible and the metastasis-free rate was better in patients treated with SLNB alone, which further supports the concept that ALND has no clinical relevance and adds nothing more than morbidity to breast cancer patients with clinically node-negative disease.
authors.affiliation: Department of Nuclear Medicine, University Hospital, Heraklion 71110, Crete, Greece. sophiak@her.forthnet.gr
authors.forename: Sophia
authors.initials: S
authors.lastname: Koukouraki
authors.forename: Elias
authors.initials: E
authors.lastname: Sanidas
authors.forename: John
authors.initials: J
authors.lastname: Askoxilakis
authors.forename: Maria
authors.initials: M
authors.lastname: Stathaki
authors.forename: Vassilis
authors.initials: V
authors.lastname: Charalambakis
authors.forename: Maria
authors.initials: M
authors.lastname: Daboudi
authors.forename: Ioanna
authors.initials: I
authors.lastname: Voutoufianaki
authors.forename: Maria
authors.initials: M
authors.lastname: Kafousi
authors.forename: Eustathios
authors.initials: E
authors.lastname: Stathopoulos
authors.forename: Dimitris
authors.initials: D
authors.lastname: Tsiftsis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Karkavitsas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla / Q000473:pathology* / Q000601:surgery; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D004396:Coloring Agents; D005188:False Negative Reactions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012008:Recurrence; D021701:Sentinel Lymph Node Biopsy; D013668:Technetium Tc 99m Aggregated Albumin
chemical_list: D004396:Coloring Agents; D013668:Technetium Tc 99m Aggregated Albumin