title: Processing sentinel nodes in breast cancer: when and how many?
abstract: OBJECTIVE
  To analyze a series of sentinel nodes (SNs) from patients with node-positive breast cancer to determine their diagnostic value, to delineate a working algorithm, and to assess the clinical value of our common practice
  
  
  METHODS
  A prospectively collected database.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  One hundred five patients with node-positive breast cancer who underwent SN biopsy.
  
  
  METHODS
  The diagnostic value of SNs by analyzing the sensitivity of processing the hottest, 2 hottest, hot and blue, or hot, blue, and suspicious SNs.
  
  
  RESULTS
  Three hundred fifty-three axillary SNs were recorded in the database. An analysis of the 282 radioactive axillary nodes for which the 10-second count was recorded reveals that the most radioactive node was positive in 73 of 94 analyzable patients (77.7%). Consideration of the 2 most intense axillary nodes was sufficient to diagnose nodal disease in an additional 12 patients, representing a significant increase in sensitivity to 90.4% (P < .001). Examination of all other radioactive nodes did not diagnose any additional cases. On the basis of all 105 patients, consideration of nonradioactive blue axillary nodes did not add significant diagnostic value relative to testing only radioactive nodes: sensitivity of 86.7% vs 88.6% (P = .50), whereas consideration of all hot, blue, and suspicious nodes improved sensitivity to 96.2% (P = .002).
  
  
  CONCLUSIONS
  Processing of the 2 hottest nodes, along with suspicious but nonhot and nonblue nodes, is sufficient for initial axillary staging. Additional radioactive SNs should be processed only in the presence of nodal disease.
authors.affiliation: Division of Gynecologic Oncology, University of Miami-Miller School of Medicine, 1475 NW 12th Ave, Sylvester Comprehensive Cancer Center 3500, Miami, FL 33136, USA. sschuman@med.miami.edu
authors.forename: Samer
authors.initials: S
authors.lastname: Schuman
authors.forename: Gail
authors.initials: G
authors.lastname: Walker
authors.forename: Eli
authors.initials: E
authors.lastname: Avisar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000191:economics / Q000473:pathology* / Q000601:surgery*; D018567:Breast Neoplasms, Male / Q000473:pathology / Q000601:surgery; D004396:Coloring Agents; D003362:Cost-Benefit Analysis; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010173:Palpation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012394:Rosaniline Dyes; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000191:economics / Q000379:methods* / Q000592:standards / Q000639:trends
chemical_list: D004396:Coloring Agents; D019275:Radiopharmaceuticals; D012394:Rosaniline Dyes; C025484:iso-sulfan blue; C008769:sulfan blue