Sentinel lymphadenectomy in breast cancer

The sentinel lymphadenectomy (SLND) technique using blue dye alone, developed over the last eight years at the John Wayne Cancer Institute and tested for its accuracy, has been proven to precisely predict the status of the axillary lymph nodes. Techniques using radioguided surgery to detect the sentinel node have also been employed with similar results. The procedure is well tolerated, and axillary staging can be achieved with minimal morbidity. Tissue is obtained for the pathologist that represents the site most likely to harbor metastases with a minimally invasive procedure. Surgeons should validate the technique at their own institutions to ensure accuracy; mastery in removing the true sentinel node will not help if the pathologists cannot detect metastases with proficiency. Future investigation is required on patients who have only had an SLND, and whose sentinel nodes are free of metastases. These patients will require prolonged follow-up to garner recurrence and survival information that is still unavailable. With upcoming planned multicenter clinical trials, we hopefully will be able to determine the outcome of patients who have metastases in the sentinel node but have not had a completion axillary lymphadenectomy (ALND). We are enthusiastic about these trials, which will also help to define the role of SLND in the management of all patients with early breast cancer.