Skip to main content

Sentinel Lymph Node Biopsy Radiotracer Technique at Memorial Sloan-Kettering Cancer Center

  • Chapter
  • First Online:
  • 2507 Accesses

Abstract

Over the past decade, sentinel lymph node (SLN) biopsy has become well established as a new standard for axillary node staging in breast cancer. We first performed SLN biopsy in 1996, using a mapping technique which combined isotope and blue dye. Our own data combined with that of many others supports an emerging consensus that a combined technique maximizes both the success and accuracy of SLN biopsy. Our own data also show that isotope identifies the SLN more often than blue dye, and that with increasing experience the “marginal benefit” of blue dye (the proportion of procedures in which the SLN is identified by dye alone) is quite small, ∼2–3%. We have previously reported our technique of SLN biopsy in detail. Here we update those reports, focusing in particular on our mature technique for isotope mapping and is based on an experience of more than 10,000 procedures.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD   169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. 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. 1993;2:335–40.

    Article  PubMed  CAS  Google Scholar 

  2. Giuliano AE, Kirgan DM, Guenther JM, et al. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg. 1994;220:391–401.

    Article  PubMed  CAS  Google Scholar 

  3. Albertini JJ, Lyman GH, Cox C, et al. Lymphatic mapping and sentinel node biopsy in the patient with breast cancer. JAMA. 1996;276:1818–22.

    Article  PubMed  CAS  Google Scholar 

  4. Veronesi U, Paganelli G, Viale G, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med. 2003;349:546–53.

    Article  PubMed  Google Scholar 

  5. Mansel RE, Fallowfield L, Kissin M, et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: The ALMANAC Trial. J Natl Cancer Inst. 2006;98:599–609.

    Article  PubMed  Google Scholar 

  6. Purushotham AD, Upponi S, Klevesath MB, et al. Morbidity after sentinel lymph node biopsy in primary breast cancer: results from a randomized controlled trial. J Clin Oncol. 2005;23:4312–21.

    Article  PubMed  Google Scholar 

  7. Krag DN, Anderson SJ, Julian TB, et al. Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial. Lancet Oncol. 2007;8:881–8.

    Article  PubMed  CAS  Google Scholar 

  8. Kim T, Giuliano AE, Lyman GH. Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma. Cancer. 2006;106:4–16.

    Article  PubMed  Google Scholar 

  9. 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. 1998;186:423–7.

    Article  PubMed  Google Scholar 

  10. Cody HS, Fey J, Akhurst T, et al. Complementarity of blue dye and isotope in sentinel node localization for breast cancer: univariate and multivariate analysis of 966 procedures. Ann Surg Oncol. 2001;8:13–9.

    Article  PubMed  Google Scholar 

  11. Lyman GH, Giuliano AE, Somerfield MR, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol. 2005;23:7703–20.

    Article  PubMed  Google Scholar 

  12. Derossis AM, Fey J, Yeung H, Yeh SDJ, Heerdt AS, Petrek J, et al. A trend analysis of the relative value of blue dye and isotope localization in 2000 consecutive cases of sentinel node biopsy for breast cancer. J Am Coll Surg. 2001;193:473–8.

    Article  PubMed  CAS  Google Scholar 

  13. Cody HS, Borgen PI. State-of-the-art approaches to sentinel node biopsy for breast cancer: study design, patient selection, technique, and quality control at Memorial Sloan-Kettering Cancer Center. Surg Oncol. 1999;8:85–91.

    Article  PubMed  Google Scholar 

  14. Brogi E, Torres-Matundan E, Tan LK, et al. The results of frozen section, touch preparation, and cytological smear are comparable for intraoperative examination of sentinel lymph nodes: a study in 133 breast cancer patients. Ann Surg Oncol. 2005;12:173–80.

    Article  PubMed  Google Scholar 

  15. Cody III HS. Sentinel lymph node biopsy for breast cancer: does anybody not need one? Ann Surg Oncol. 2003;10:1131–2.

    Article  PubMed  Google Scholar 

  16. Specht MC, Fey JV, Borgen PI, et al. Is the clinically positive axilla in breast cancer really a contraindication to sentinel lymph node biopsy? J Am Coll Surg. 2005;200:10–4.

    Article  PubMed  Google Scholar 

  17. Linehan DC, Hill ADK, Tran KN, et al. Sentinel lymph node biopsy in breast cancer: unfiltered radioisotope is superior to filtered. J Am Coll Surg. 1999;188:377–81.

    Article  PubMed  CAS  Google Scholar 

  18. Linehan DC, Hill ADK, Akhurst T, et al. Intradermal radiocolloid and intraparenchymal blue dye injection optimize sentinel node identification in breast cancer patients. Ann Surg Oncol. 1999;6:450–4.

    Article  PubMed  CAS  Google Scholar 

  19. Chagpar AB, Martin RC, Scoggins CR, et al. Factors predicting failure to identify a sentinel lymph node in breast cancer. Surgery. 2005;138:56–63.

    Article  PubMed  Google Scholar 

  20. van der Ent FW, Kengen RA, van der Pol HA, et al. Halsted revisited: internal mammary sentinel lymph node biopsy in breast cancer. Ann Surg. 2001;234:79–84.

    Article  PubMed  Google Scholar 

  21. Estourgie SH, Tanis PJ, Nieweg OE, et al. Should the hunt for internal mammary chain sentinel nodes begin? An evaluation of 150 breast cancer patients. Ann Surg Oncol. 2003;10:935–41.

    Article  PubMed  Google Scholar 

  22. McCarter MD, Yeung H, Yeh SDJ, et al. Localization of the sentinel node in breast cancer: identical results with same-day and day-before isotope injection. Ann Surg Oncol. 2001;8: 682–6.

    Article  PubMed  CAS  Google Scholar 

  23. Port ER, Fey J, Gemignani ML, et al. Reoperative sentinel lymph node biopsy: a new option for patients with primary or locally recurrent breast carcinoma. J Am Coll Surg. 2002;195:167–72.

    Article  PubMed  Google Scholar 

  24. Port ER, Garcia-Etienne CA, Park J, et al. Reoperative sentinel lymph node biopsy: a new frontier in the management of ipsilateral breast tumor recurrence. Ann Surg Oncol. 2007;14:2209–14.

    Article  PubMed  Google Scholar 

  25. McMasters KM, Tuttle TM, Carlson DJ, et al. Sentinel lymph node biopsy for breast cancer: a suitable alternative to routine axillary dissection in multi-institutional practice when optimal technique is used. J Clin Oncol. 2000;18:2560–6.

    PubMed  CAS  Google Scholar 

  26. Martin RCG, Fey J, Yeung H, et al. Highest isotope count does not predict sentinel node positivity in all breast cancer patients. Ann Surg Oncol. 2001;8:592–7.

    Article  PubMed  CAS  Google Scholar 

  27. McCarter MD, Yeung H, Fey J, et al. The breast cancer patient with multiple sentinel nodes: when to stop? J Am Coll Surg. 2001;192:692–7.

    Article  PubMed  CAS  Google Scholar 

  28. Martin RCG, Derossis A, Fey J, et al. Intradermal isotope injection is superior to intramammary in sentinel node biopsy for breast cancer. Surgery. 2001;130:432–8.

    Article  PubMed  CAS  Google Scholar 

  29. Van Zee KJ, Manasseh DM, Bevilacqua JL, et al. A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy. Ann Surg Oncol. 2003;10:1140–51.

    Article  PubMed  Google Scholar 

  30. Park J, Fey JV, Naik AM, Borgen PI, Cody HS. A declining rate of completion axillary dissection in sentinel lymph node-positive breast cancer patients is associated with the use of a multivariate nomogram. Ann Surg. 2007;245:462–8.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hiram S. Cody III .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer New York

About this chapter

Cite this chapter

Goyal, A., Cody, H.S. (2010). Sentinel Lymph Node Biopsy Radiotracer Technique at Memorial Sloan-Kettering Cancer Center. In: Dirbas, F., Scott-Conner, C. (eds) Breast Surgical Techniques and Interdisciplinary Management. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-6076-4_40

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-6076-4_40

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-6075-7

  • Online ISBN: 978-1-4419-6076-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics