Validity of the study of sentinel lymph nodes in the treatment of breast carcinoma

Since it was introduced in the 1990s, axillary sentinel lymph-node biopsy has been rapidly and widely adopted to avoid complete axillary dissection (though this is still the standard procedure). The aims of the study were two-fold: (i) to determine the value of different techniques of sentinel lymph-node identification and (ii) to verify the predictive value of such procedures through histological examination of the sentinel lymph node and axillary dissection in the same patients. Both sentinel lymph-node biopsy and axillary dissection were performed in 230 patients with T1 and T2 (< 3 cm) carcinoma of the breast. Preoperative lymphoscintigraphy was able to identify the sentinel lymph node in 97.4% of cases, but, with an intraoperative hand-held probe, it was possible to find the sentinel lymph node in 98.2% of cases (226/230 patients). The sentinel lymph node was metastatic in 49.1% of cases (111/226 patients) and negative in 50.9% (115/226). The incidence of false-negative cases was 2.6% (2/115 patients). The predictive value of the sentinel lymph node was 98.7%. Finally, lymph-mode mapping is possible is a very high percentage of patients and therefore it is always advisable to use all three methods of identification together. The diagnostic reliability of sentinel lymph-node status is equally high. At present there no studies are available with a long-term follow-up to confirm these findings, and therefore axillary dissection is still the standard surgical treatment for breast cancer.