![]() Ī large choice of dyes and radiopharmaceuticals (usually 99mTc sulphur colloid) are available. In a recent analysis of over 35,000 breast cancer patients diagnosed with T1–T2 tumours, clinically negative nodes and without distant metastases, 70% underwent the procedure and for 65% it was the final axillary treatment. Introduction of SLNB has led to stage migration as is reflected by the small but significant increase in the proportion of patients with positive axillary lymph nodes after adjustment for tumour size and age. New models using just three variables have been developed to predict the accuracy of non-sentinel lymph node status. Current practice is to perform a completion ALND for breast cancer patients although <50% will have non-sentinel node metastases. Subsequent studies have shown that comparing the results of SLNB to ALND indicate that the sentinel node is representative of the presence or absence of metastases in the remainder of the nodal basin (with a false negative rate of less than 2% in most series). Early prospective studies validated the concept 13–16. The technique assumes orderly progression of tumour spread to the regional nodes and biopsy of the first node in the lymphatic chain at risk for metastasis should therefore reflect involvement of the remaining nodes. Sentinel lymph node biopsy (SLNB) is a minimally invasive alternative to ALND for nodal staging in breast cancer, which is associated with low post-operative long-term morbidity. Moreover, the frequency of patients with metastatic disease increases significantly if a sentinel lymph node policy is in place. ![]() ![]() If the sentinel node is positive there is a 40% risk that higher order nodes may also be involved with metastatic disease. The sentinel node is the first draining node on the direct drainage pathway from the primary tumour site. Axillary lymph node dissection (ALND) surgery carries a significant morbidity with complications such as lymphoedema, pain, numbness and limited shoulder movement. The prognosis of breast cancer is determined primarily by axillary lymph node status. ![]()
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