15 Alex and Krag described direct localization of sentinel nodes with radioactive tracers and a hand-held gamma probe, demonstrating in an animal model that the radioactive-tracer and blue-dye methods were equally effective in locating lymph nodes. used a blue dye to identify the lymphatic duct that drained into the sentinel nodes in patients with melanoma. 7-13 More than 20 years ago, Cabanas proposed that the lymph nodes that first receive drainage from a tumor, termed sentinel nodes, could be removed by limited surgery and examined to determine whether more extensive lymphadenectomy should be performed. 6 Dyes, radiographic contrast agents, and radioactive tracers have been used to identify such lymph nodes. The first stop along the route of lymphatic drainage from a primary tumor is a limited set of regional lymph nodes. 2-5 A potential alternative to axillary lymphadenectomy is sentinel-node resection. 1 However, over 80 percent of women who undergo axillary dissection have at least one postoperative complication in the arm, and psychological distress is common. The histologic status of axillary lymph nodes, one of the most important prognostic indicators in patients with breast cancer, directly affects clinical management. However, the procedure can be technically challenging, and the success rate varies according to the surgeon and the characteristics of the patient. Conclusionsīiopsy of sentinel nodes can predict the presence or absence of axillary-node metastases in patients with breast cancer.
Three percent of positive sentinel nodes were in nonaxillary locations. The sentinel nodes were outside the axilla in 8 percent of cases and outside of level 1 nodes in 11 percent of cases. The accuracy of the sentinel nodes with respect to the positive or negative status of the axillary nodes was 97 percent (392 of 405) the specificity of the method was 100 percent, the positive predictive value was 100 percent, the negative predictive value was 96 percent (291 of 304), and the sensitivity was 89 percent (101 of 114). The pathological status of the sentinel nodes was compared with that of the remaining axillary nodes. The overall rate of identification of hot spots was 93 percent (in 413 of 443 patients).
All patients underwent a complete axillary lymphadenectomy. Sentinel nodes subjacent to hot spots were removed. “Hot spots” representing underlying sentinel nodes were identified with a gamma probe. The technique involved the injection of 4 ml of technetium-99m sulfur colloid (1 mCi ) into the breast around the tumor or biopsy cavity. We enrolled 443 patients with breast cancer. To confirm this finding, we conducted a multicenter study of the method as used by 11 surgeons in a variety of practice settings. Pilot studies indicate that probe-guided resection of radioactive sentinel nodes (the first nodes that receive drainage from tumors) can identify regional metastases in patients with breast cancer. The most trusted, influential source of new medical knowledge and clinical best practices in the world.
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