Axillary staging utilizing selective sentinel lymphadenectomy for patients with invasive breast carcinoma.

The clinical staging of the regional lymphatics in patients with breast carcinoma is currently receiving much attention in the medical literature. However, controversy still exists regarding surgical staging of the axilla. Most recently, the technique of selective sentinel lymphadenectomy has been applied to staging of breast carcinoma. Our experience with this technique is presented. From July 1, 1995 through December 31, 1996, 20 patients underwent 21 selective sentinel lymphadenectomies prior to level I, level II, and partial level III axillary dissections. There were 13 modified radical mastectomies and 8 segmental mastectomies. The median number of lymph nodes per specimen was 9 (range, 1-31). The sentinel node was identified in 14 patients (66%). Dual sentinel nodes were identified during 3 procedures. The sentinel nodes were negative in 9 procedures, of which all axillary nodes dissected were negative. The sentinel node was positive in 5 procedures for a 100 per cent predictive value. The sentinel node was the only positive node in 3 of the 5 patients, and 2 of these were microscopic (less than 2 mm). There were no associated complications due to the sentinel node biopsy. These results add to the growing literature supporting the feasibility of the sentinel node technique for accurately staging breast carcinoma. This technique is sensitive and specific and can be performed with minimal morbidity.