title: Evaluation of sentinel lymph node biopsy in clinically node-negative breast cancer.
abstract: BACKGROUND
  In patients with clinically node-negative breast cancer, diagnosed with palpation and several types of imaging examination, sentinel lymph nodes accurately predict the status of the other axillary nodes, which determine the nature of subsequent adjuvant treatment. In addition, compared with axillary lymph node dissection, sentinel-node biopsy results in less postoperative morbidity, including pain, numbness, swelling, and reduced mobility in the ipsilateral arm.
  
  
  METHODS
  We analyzed the validity of the sentinel node biopsy procedure using dual-agent injection of blue dye and radioactive colloid performed in our hospital from May 2006 through March 2010. A total of 258 breasts of 253 patients were studied. Simultaneous axillary lymph node dissection was performed only if rapid intraoperative diagnosis identified metastasis in sentinel lymph nodes. The identification rate, accuracy, provisional false-negative rate, which was calculated with data from all 65 patients whose sentinel lymph nodes had metastasis, and axillary recurrence rate of sentinel node biopsy were calculated.
  
  
  RESULTS
  The sentinel node identification rate was 99.2%, and the accuracy of sentinel lymph node status was 98.0%. The provisional false-negative rate was 7.7%. During an observation period averaging 24 months, axillary recurrence was observed in only 1 of 256 cases (0.4%), and there were no cases of parasternal recurrence. In patients who underwent sentinel-node biopsy without axillary lymph node dissection, there was no obvious morbidity.
  
  
  CONCLUSIONS
  Our sentinel-node biopsy procedure yielded satisfactory results, which were not inferior to the results of previous clinical trials. Thus, we conclude our sentinel-node biopsy procedure is feasible. If the efficacy and safety of sentinel-node biopsy are confirmed in several large-scale randomized controlled trials in Europe and the United States, sentinel-node biopsy will become a standard surgical technique in the management of clinically node-negative breast cancer.
authors.affiliation: Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan. shinya1s@nms.ac.jp
authors.forename: Shinya
authors.initials: S
authors.lastname: Iida
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Haga
authors.forename: Koji
authors.initials: K
authors.lastname: Yamashita
authors.forename: Keiko
authors.initials: K
authors.lastname: Yanagihara
authors.forename: Tomoko
authors.initials: T
authors.lastname: Kurita
authors.forename: Ryusuke
authors.initials: R
authors.lastname: Murakami
authors.forename: Shin-ichiro
authors.initials: S
authors.lastname: Kumita
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Tsuchiya
authors.forename: Kiyonori
authors.initials: K
authors.lastname: Furukawa
authors.forename: Eiji
authors.initials: E
authors.lastname: Uchida
mesh_terms: D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000473:pathology*; D018567:Breast Neoplasms, Male / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*