The breast and regional lymph nodes were scanned preoperatively with a gamma detection probe (Neoprobe 1000/1500, Neoprobe Corporation, Dublin, Ohio) to identify the location of the sentinel lymph node using the 10% rule (activity >10% of the background) in regional nodes. The tracer solution was infiltrated around the tumor or biopsy site 1 to 2 hours before surgery. On the day of surgery, each patient was injected with sulfur colloid solution labeled with 1.0 mCi of technetium 99m. Sentinel lymph node examination with the protocol we describe, combined with axillary dissection, increased the yield of metastatic disease by identifying 8 additional cases of nodal metastatic disease (an increase of 28%), as compared to standard axillary nodal dissection and single-section sentinel lymph node examination alone. A predictive value of 96.4% confirms that sentinel lymph node biopsy is most likely to contain metastatic carcinoma. Caution should be used in accepting sentinel node biopsy alone as the only procedure for staging due to a high false-negative rate (10.7%). The sensitivity was 89% and specificity was 100%.Ĭonclusion.-Immunohistochemistry and multiple-level sectioning increased detection of metastases by 7.8% in sentinel lymph nodes. The concordance rate between sentinel lymph nodes and axillary lymph nodes was 96.4%. Of the remaining 59 cases that were negative on HE and immunohistochemistry, axillary dissection revealed 3 cases that had metastases in the axillary lymph nodes. The total percentage of cases with sentinel lymph node metastases detected by HE staining and immunohistochemistry was 29.7%. Additional immunohistochemical stains for keratin and HE stains on specimens from these 64 patients showed an additional 5 patients (7.8%) to be positive for lymph node micrometastases (<2 mm). The remaining 64 negative patients (76.1%) were tumor free on sentinel lymph nodes at level 1 HE. Results.-Hematoxylin-eosin staining identified 20 patients (23.8%) with sentinel node metastases. Materials and Methods.-A retrospective analysis of 84 breast cancer patients with sentinel node biopsies, who also underwent axillary dissection, was conducted using a standard protocol (3 levels of immunohistochemical stains for keratin and 2 levels of hematoxylin-eosin (HE) stains on the first 3 negative lymph nodes). Objectives.-We designed our study to determine the usefulness of a standard protocol for evaluating sentinel lymph node metastases and to assess the value of sentinel node biopsy as the only procedure in nodal staging in breast cancer patients. However, sentinel node biopsy in breast cancer is currently a controversial procedure and continues to provoke debate. ![]() ![]() Context.-Previous investigations on sentinel lymph node biopsies have demonstrated their importance in nodal staging of patients with breast cancer.
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