Department of Surgery, Sung Kyun Kwan University, College of Medicine, Samsung Medical Center, Seoul, Korea.
ABSTRACT
PURPOSE: Recently, results of many trials that intend to decide the axillary status through more conservative procedures are reported. One of these is sentinel node biopsy. This method is regarded as reasonable and selective.
Some investigators tend to omit axillary dissection in the patient who is determined to have negative node clinically and negative result in sentinel node biopsy procedure. This study was designed to know how accurate the sentinel node biopsy method can predict axillary nodal status.
MATERIALS AND METHOD: The patients group was selected from Department of Surgery at SMC, consisting of 111 patients with surgically curable breast cancer from Sept. 1995 to Apr. 1997. Isosulfan blue was injected in the center of mass and the margins of 4 quadrant under the general anesthesia.
Axillary dissection was done 5 minutes after injection to identify the stained lymphatics. When stained lymphatics were identified, dissection was performed along the lymphatics bidirectionally to detect the stained lymph node nearest to the primary tumor (sentinel node). After frozen biopsy of sentinel node, routine axillary node dissection was performed. Results of frozen biopsy were compared with the final pathologic results.
RESULTS: Sentinel node was detected in 80 of the 111 cases (72.1%) and there were 44 (55.0%) axillary metastasis cases in sentinel node detection group. In 14 of 44 cases, sentinel node was only positive. In 5 of 41, sentinel node were falsely negative for malignancy. Negative predictive value of the method is 87.8% (36/41).
CONCLUSION: Sentinel node biopsy method can predict the axillary nodal status in patients with breast cancer. This method can lead to more conservative treatment, eventually omitting axillary nodal dissection in selected patients.
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