Background

There continues to be significant debate with regard to the optimal technique for sentinel node biopsy (SNB), and it is the topic of study in many clinical trials. Since its introduction for melanoma and subsequently breast cancer, SNB has been applied with an array of techniques to facilitate its accurate identification. Initially, SNB was described with blue dye identification.1 Subsequent studies investigated the use of radiocolloid and finally a combination of the two was utilized.2,3 In addition, optimal application of these tracers has influenced SNB. Sifting through the techniques reported in current literature, we have identified a method that appears to consistently identify the SLN while minimizing the false negative rate (Fig. 8.1).

Table 8.2. Published studies of breast lymphatic mapping and sentinel lymph node biopsy

Pos

False

Number

SLN Identified

Pos

Axillary

Neg

Author

Date

of Patients N (%)

Technique

SLN

LN

Rate

Giuliano

1994

174

114 (66%)

Blue dye alone

37

42

11.9%

et al1

Krag et al

1996

70

50 (71%)

Radiocolloid

21

21

0%

alone

Albertini

1996

62

57 (92%)

Blue dye plus

18

18

0%

et al3

radiocolloid

Giuliano

1997

107

100 (93%)

Blue dye alone

42

42

0%

et al10

Veronesi

1997

163

160 (98%)

Radiocolloid

81

85

4.7%

et al5

alone (subdermal injection)

Barnwell

1998

42

38 (90%)

Blue dye plus

15

15

0

et al18

radiocolloid

Krag et al19

1998

443

413 (91%)

Radiocolloid

11%

alone

Flett et al20

1998

68

56 (82%)

Blue dye alone

53

56

5%

Bass et al21

1999

700

665 (95%)

Blue dye plus radiocolloid

238

0.84%

0 0

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