Background Pilot studies indicate that probe-guided resectionof radioactive sentinel nodes (the first nodes that receivedrainage from tumors) can identify regional metastases in patientswith breast cancer. To confirm this finding, we conducted amulticenter study of the method as used by 11 surgeons in avariety of practice settings.
Methods We enrolled 443 patients with breast cancer. The techniqueinvolved the injection of 4 ml of technetium-99m sulfur colloid(1 mCi [37 MBq]) into the breast around the tumor or biopsycavity. "Hot spots" representing underlying sentinel nodes wereidentified with a gamma probe. Sentinel nodes subjacent to hotspots were removed. All patients underwent a complete axillarylymphadenectomy.
Results The overall rate of identification of hot spots was93 percent (in 413 of 443 patients). The pathological statusof the sentinel nodes was compared with that of the remainingaxillary nodes. The accuracy of the sentinel nodes with respectto the positive or negative status of the axillary nodes was97 percent (392 of 405); the specificity of the method was 100percent, the positive predictive value was 100 percent, thenegative predictive value was 96 percent (291 of 304), and thesensitivity was 89 percent (101 of 114). The sentinel nodeswere outside the axilla in 8 percent of cases and outside oflevel 1 nodes in 11 percent of cases. Three percent of positivesentinel nodes were in nonaxillary locations.
Conclusions Biopsy of sentinel nodes can predict the presenceor absence of axillary-node metastases in patients with breastcancer. However, the procedure can be technically challenging,and the success rate varies according to the surgeon and thecharacteristics of the patient.
Source Information
From the Cancer Center (D.K.) and the Departments of Surgery (D.K., S.H.), Pathology (D.W.), and Biometry (T.A.), University of Vermont, Burlington; the Sylvester Cancer Center, Miami (F.M.); the Arkansas Cancer Research Center, Little Rock (V.S.K.); Walter Reed Army Medical Center, Washington, D.C. (C.S.); Benedictine Hospital, Kingston, N.Y. (S.F.); Charleston Area Medical Center, Charleston, W.V. (R.K.); Massachusetts General Hospital, Boston (M.G.); Baylor University Medical Center, Dallas (J.K.); and St. Paul Hospital, Dallas (P.B.). Other authors were Pat Whitworth, Jr., M.D., Nashville Surgical Associates, Nashville; Roger Foster, Jr., M.D., Crawford Long Hospital, Emory University, Atlanta; and Kambiz Dowlatshahi, M.D., Rush–Presbyterian–St. Luke's Medical Center, Chicago.The views expressed in this article are solely those of the authors and do not necessarily represent the official views of the National Cancer Institute, the federal government, or the Department of Defense.
Address reprint requests to Dr. Krag at Given Bldg. E309, University of Vermont, Burlington, VT 05405.
Sentinel-Lymph-Node Biopsy
Schillaci O., Scopinaro F., Abramson L. R., Retsas S., Krag D. N., Moffat F. L., Ashikaga T., McMasters K. M., Edwards M. J., Ross M. I.
Extract |
Full Text
N Engl J Med 1999;
340:317-319, Jan 28, 1999.
Correspondence
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