Advertisement

Breast Cancer

, Volume 6, Issue 1, pp 13–22 | Cite as

Sentinel lymph node mapping in breast cancer

  • Hiram S. Cody
Review Article

Abstract

Sentinel lymph node (SLN) biopsy is a rapidly emerging treatment option for the patient with early stage invasive breast cancer and a clinically negative axilla. In the era of mammographic detection, SLN biopsy has the potential to eliminate axillary dissection for the enlarging cohort of breast cancer patients who are node-negative. With experience, using radioisotope, blue dye, or both, SLN are successfully localized in more than 90% of cases. The effects of isotope and blue dye may be additive. The SLN reliably predicts axillary node status in 98% of all patients, and 95% of those who are node-positive. The operation is best learned under a formalized protocol in which a backup axillary dissection is performed to validate the technique during one’s early experience. Enhanced pathologic analysis, including serial sections and immunohistochemical staining, is an essential element of the procedure. In experienced hands, SLN biopsy has less morbidity and greater accuracy than conventional axillary dissection.

Key words Breast cancer Axillary node Sentinel node 

Abbreviations

DCIS

Intraductal carcinoma

H&E

Hematoxylin-eosin

IHC

Immunohistochemical

NS

Normal saline

RT-PCR

Reverse transcriptase polymerase chain reaction

SLN

Sentinel lymph node

Tc-99m SC

Tc-99m sulfur colloid

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1).
    Petrek JA, Blackwood MM: Axillary dissection; Current practice and technique.Curr Probl Surg 32:259–323, 1995.CrossRefGoogle Scholar
  2. 2).
    Sappey PC: Anatomie, Physiologie, Pathologie des Vesseaux Lymphatiques Consideres chez l’Homme et les Vertebres, A. Delahaye and E. Lecrosnier, Paris, 1885.Google Scholar
  3. 3).
    Halsted WS: The results of operations for the cure of cancer of the breast performed at the Johns Hopkins Hospital from June 1889 to January 1894.Johns Hopkins Hosp Rep 4:297–350, 1894.Google Scholar
  4. 4).
    Turner-Warwick RT: The lymphatics of the breast.Br J Surg 46:574–582, 1959.PubMedCrossRefGoogle Scholar
  5. 5).
    Halsell JT, Smith JR, Bentlage CR,et al: Lymphatic drainage of the breast demonstrated by vital dye staining and radiography.Ann Surg 162:221–226, 1965.PubMedCrossRefGoogle Scholar
  6. 6).
    Kett K, Varga G, Lukacs L: Direct lymphography of the breast.Lymphology 1:3–12, 1970.Google Scholar
  7. 7).
    Borgstein P, Meijer S: Historical perspective of lymphatic tumour spread and the emergence of the sentinel node concept.Eur J Surg Oncol 24:85–89, 1998.PubMedCrossRefGoogle Scholar
  8. 8).
    Cabanas R: An approach for the treatment of penile carcinoma.Cancer 39:456–466, 1977.PubMedCrossRefGoogle Scholar
  9. 9).
    Morton DL, Wen DR, Wong JH,et al: Technical details of intraoperative lymphatic mapping for early stage melanoma.Arch Surg 127:392–399, 1992.PubMedGoogle Scholar
  10. 10).
    Brady MS, Coit DG: Sentinel lymph node evaluation in melanoma.Arch Dermatol 133:1014–1020, 1997.PubMedCrossRefGoogle Scholar
  11. 11).
    Krag DN, Weaver DL, Alex JC,et al: Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe.Surg Oncol 2:335–340, 1993.PubMedCrossRefGoogle Scholar
  12. 12).
    Giuliano AE, Kirgan DM, Guenther JM,et al: Lymphatic mapping and sentinel lymphadenectomy for breast cancer.Ann Surg 220:391–401, 1994.PubMedCrossRefGoogle Scholar
  13. 13).
    Veronesi U, Paganelli G, Galimberti V,et al: Sentinel node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes.Lancet 349:1864–1867, 1997.PubMedCrossRefGoogle Scholar
  14. 14).
    Pijpers R, Hoekstra OS, Collet GJ,et al: Impact of lymphoscintigraphy on sentinel node identification with technetium-99m-colloidal albumin in breast cancer.J Nucl Med 38:366–368, 1997.PubMedGoogle Scholar
  15. 15).
    Roumen RMH Valkenburg JGM, Geuskens LM: Lymphoscintigraphy and feasibility of sentinel node biopsy in 83 patients with primary breast cancer.Eur J Surg Oncol 23:495–502, 1997.PubMedCrossRefGoogle Scholar
  16. 16).
    Galimberti V, Zurrida S, Zucali P,et al: Can sentinel node biopsy avoid axillary dissection in clinically node-negative breast cancer patients?The Breast 7:8–10, 1998.CrossRefGoogle Scholar
  17. 17).
    Borgstein PJ, Pijpers R, Comans EF,et al: Sentinel lymph node biopsy in breast cancer; Guidelines and pitfalls of lymphoscintigraphy and gamma probe detection.J Am Coll Surg 186:275–283, 1998.PubMedCrossRefGoogle Scholar
  18. 18).
    Krag DN, Ashikaga T, Harlow SP,et al: Development of sentinel node targeting technique in breast cancer patients.The Breast Journal 4:67–74, 1998.CrossRefGoogle Scholar
  19. 19).
    Offodile R, Hoh C, Barsky SH,et al: Minimally invasive breast cancer staging using lymphatic mapping with radiolabeled dextran.Cancer 82:1704–1708, 1998.PubMedCrossRefGoogle Scholar
  20. 20).
    Giuliano AE, Jones RC, Brennan M,et al: Sentinel lymphadenectomy in breast cancer.J Clin Oncol 15:2345–2350, 1997.PubMedGoogle Scholar
  21. 21).
    Guenther JM, Krishnamoorthy M, Tan LR: Sentinel lymphadenectomy for breast cancer in a community managed care setting.Cancer J Sci Am 3:336–340, 1997.PubMedGoogle Scholar
  22. 22).
    Flett MM, Going JJ, Stanton PD,et al: Sentinel node localization in patients with breast cancer.Br J Surg 85:991–993, 1998.PubMedCrossRefGoogle Scholar
  23. 23).
    Albertini JJ, Lyman GH, Cox C,et al: Lymphatic mapping and sentinel node biopsy in the patient with breast cancer.JAMA 276:1818–1822, 1996.PubMedCrossRefGoogle Scholar
  24. 24).
    Borgstein PJ, Meijer S, Pijpers R: Intradermal blue dye to identify sentinel lymphnode in breast cancer.Lancet 349:1668–1669, 1997.PubMedCrossRefGoogle Scholar
  25. 25).
    O’Hea BJ, Hill ADK, El-Shirbiny A,et al: Sentinel lymph node biopsy in breast cancer; Initial experience at Memorial Sloan-Kettering Cancer Center.J Am Coll Surg 186:423–427, 1998.PubMedCrossRefGoogle Scholar
  26. 26).
    Barnwell JM, Arredondo MA, Kollmorgen D,et al: Sentinel node biopsy in breast cancer.Ann Surg Oncol 5:126–130, 1998.PubMedCrossRefGoogle Scholar
  27. 27).
    Turner RR, Ollila DW, Krasne DL,et al: Histologic validation of the sentinel lymph node hypothesis for breast carcinoma.Ann Surg 226:271–278, 1997.PubMedCrossRefGoogle Scholar
  28. 28).
    Linehan DC, Hill ADK, Tran KN,et al: Sentinel lymph node localization in breast cancer; Unfiltered isotope is superior to filtered. SSO Cancer Symposium 1998, p51. Abstract.Google Scholar
  29. 29).
    Gershenwald JE, Colome MI, Lee JE,et al: Patterns of recurrence following a negative sentinel lymph node biopsy in 243 patients with stage I or II melanoma.J Clin Oncol 16:2253–2260, 1998.PubMedGoogle Scholar
  30. 30).
    Ollila DW, Giuliano AE: Intraoperative lymphatic mapping and sentinel lymphadenectomy using isosul- fan blue dye.Breast Dis 8:297–300, 1998.Google Scholar
  31. 31).
    International (Ludwig) Breast Cancer Study Group: Prognostic importance of occult axillary lymph node micrometastases from breast cancers.Lancet 335:1565–568, 1990.Google Scholar
  32. 32).
    DeMascarel I, Bonichon F, Coindre JM,et al: Prognostic significance of breast cancer axillary lymph node micrometastases assessed by two special techniques; Reevaluation with longer follow-up.Br J Cancer 66:523–527, 1992.Google Scholar
  33. 33).
    Hainsworth PJ, Tjandra JJ, Stillwell RG,et al: Detection and significance of occult micrometastases in node-negative breast cancer.Br J Surg 80:459–463, 1993.PubMedCrossRefGoogle Scholar
  34. 34).
    Veronesi U, Cascinelli N, Bufalino R: Risk of internal mammary lymph node metastases and its relevance on prognosis of breast cancer patients.Ann Surg 198:681–684, 1983.PubMedCrossRefGoogle Scholar
  35. 35).
    Cody HS, Urban JA: Internal mammary node status; A major prognosticator in axillary node-negative breast cancer.Ann Surg Oncol 2:32–37, 1995.PubMedCrossRefGoogle Scholar
  36. 36).
    McNeil C: Four large studies aim to resolve sentinel node debate.JNCI 90:729, 1998.Google Scholar
  37. 37).
    Fisher B: Laboratory and clinical research in breast cancer; A personal adventure; The David A. Karnofsky memorial lecture.Cancer Res 40:3863–3874, 1980.PubMedGoogle Scholar

Copyright information

© The Japanese Breast Cancer Society 1999

Authors and Affiliations

  • Hiram S. Cody
    • 1
    • 2
  1. 1.The Breast Service, Department of SurgeryMemorial Sloan Kettering Cancer CenterNew York
  2. 2.Clinical SurgeryCornell University Medical CollegeNew York

Personalised recommendations