FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 349:546-553 August 7, 2003 Number 6 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Krag, D. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Although numerous studies have shown that the status of the sentinel node is an accurate predictor of the status of the axillary nodes in breast cancer, the efficacy and safety of sentinel-node biopsy require validation.

Methods From March 1998 to December 1999, we randomly assigned 516 patients with primary breast cancer in whom the tumor was less than or equal to 2 cm in diameter either to sentinel-node biopsy and total axillary dissection (the axillary-dissection group) or to sentinel-node biopsy followed by axillary dissection only if the sentinel node contained metastases (the sentinel-node group).

Results The number of sentinel nodes found was the same in the two groups. A sentinel node was positive in 83 of the 257 patients in the axillary-dissection group (32.3 percent), and in 92 of the 259 patients in the sentinel-node group (35.5 percent). In the axillary-dissection group, the overall accuracy of the sentinel-node status was 96.9 percent, the sensitivity 91.2 percent, and the specificity 100 percent. There was less pain and better arm mobility in the patients who underwent sentinel-node biopsy only than in those who also underwent axillary dissection. There were 15 events associated with breast cancer in the axillary-dissection group and 10 such events in the sentinel-node group. Among the 167 patients who did not undergo axillary dissection, there were no cases of overt axillary metastasis during follow-up.

Conclusions Sentinel-node biopsy is a safe and accurate method of screening the axillary nodes for metastasis in women with a small breast cancer.

Source Information

From the Divisions of Senology (U.V., A.L., S.Z., V.G., M.I., P.V., R.G.), Nuclear Medicine (G.P., C.D.), Pathology (G.V., G.R.), Epidemiology (C.R., P.M.), and Anaesthesiology (F.D.), European Institute of Oncology; and the University of Milan School of Medicine (G.V.) — both in Milan, Italy.

Address reprint requests to Dr. Umberto Veronesi at the Istituto Europeo di Oncologia, Via G. Ripamonti 435, 20141 Milan, Italy, or at umberto.veronesi{at}ieo.it.

Full Text of this Article

Related Letters:

Sentinel-Node Biopsy in Breast Cancer
Badwe R. A., Thorat M. A., Parmar V. V., De Salvo G. L., Del Bianco P., Zavagno G., Munster A. M., McMasters K. M., Veronesi U., Maisonneuve P., Krag D., Ashikaga T.
Extract | Full Text | PDF  
N Engl J Med 2003; 349:1968-1971, Nov 13, 2003. Correspondence

HOME  |  SUBSCRIBE  |  SEARCH  |  CURRENT ISSUE  |  PAST ISSUES  |  COLLECTIONS  |  PRIVACY  |  HELP  |  beta.nejm.org Comments and questions? Please contact us. The New England Journal of Medicine is owned, published, and copyrighted © 2008 Massachusetts Medical Society. All rights reserved.