Sentinel node biopsy for breast cancer: yes, less surgery is better surgery

Breast surgery evolves towards always more precise, but less invasive techniques. The halstedian concept of radical surgery has been abandoned and the majority of patients are now allowed to preserve their breasts provided they receive radiation therapy after surgery. In many institutions standard axillary lymph-node dissection is being replaced by the less invasive and probably also more accurate staging technique known as sentinel-node dissection. Nevertheless, the procedure requires interdisciplinary collaboration and rigorous quality control monitoring to provide optimal results. Many issues, some of which will be discussed in the light of our personal experience, still need to be tested in clinical controlled trials.

Breast cancer; Sentinel node dissection; Axillary node dissection

[1] Tanis P. J., Nieweg 0. E., Valdes Olmos R. A. et al.: "History of sentinel node and validation of the technique". Breast Cancer. Res., 2001, 3, 109.

[2] Halsted W. S.: "The results of operations for the cure of cancer of the breast performed at the Johns Hopkins Hospital from June 1889 to January 1894". Johns Hopkins Hosp. Bull., 1894, 4, 297

[3] Fisher B.: "Seminars of Bernard Fisher 1960 - nature of cancer as systemic disease?". Bull. Soc. Int. Chir., 1972, 31 (6), 604.

[4] Fisher B., Fisher E. R.: "Barrier function of lymph node to tumor cells and erythrocytes". Cancer, 1967, 20, 1907.

[5] The ATAC Trialist Group: "Anastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early breast cancer: first results of the ATAC randomised trial". Lancet, 2002, 359, 2131.

[6] Baum M., Chaplain M. A. J., Anderson A. R. A. et al.: "Does breast cancer exist in a state of chaos?". Eur. J. Cancer, 1999, 35, 886.

[7] Hellman S.: "Natural history of small breast cancers". J. Clin. Oncol., 1994, 12, 2229.

[8] Cabanas R. M.: "An approach for the treatment of penile carcinoma". Cancer, 1977, 39, 456.

[9] Morton D. L., Wen D.R., Wong J. H. et al.: "Technical details of intraoperative lymphatic mapping for early stage melanoma" Arch. Surg., 1992, 127, 392.

[10] Giuliano A. E., Kirgan D. M., Guenther J. M., Morton D. L.: "Lymphatic mapping and sentinel lymphadenectomy for breast cancer". Ann. Surg., 1994, 220, 391.

[11] Krag D. N., Weaver D. L., Alex J. C., Fairbank J. T.: "Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe". Surg. Oncol., 1993, 2, 335.

[12] Turner R. R., Ollila D. W., Krasne D. L., Giuliano A. E.: "Histopathologic validation of the sentinel lymph node hypothesis for breast carcinoma". Ann. Surg., 1997, 226, 271.

[13] Hsueh E. C., Turner R.R., Glass E. C., Brenner R. J., Brennan M. B., Giuliano A. E.: "Sentinel node biopsy in breast cancer". J Am. Coll. Surg., 1999, 189, 207.

[14] Schwartz G. F., Giuliano A. E., Veronesi U. and the Consensus Conference Committee. Breast 1., 2002, 3, 126.

[15] Tafra L., Chua A., Madigan M. et al.: "Sentinel node biopsy for breast tumors 4 cm or greater". Eur. J. Nucl. Med., 1999, 26 (suppl.), 93.

[16] Bedrosian I.,R eynolds C.,M ickR . et al.: "Accuracy of sentinel lymph node biopsy in patients with large primary breast tumors" Cancer, 2000, 88, 2540.

[17] Krag D., Weaver D., Ashikaga T. et al.: "Sentinel node biopsy and breast cancer: a multicenter validation study". N. Engl. J. Med., 1998, 339, 941.

[18] Feldman S. M., Krag D. N., McNally R. K. et al.: "Limitation in gamma probe localization of the sentinel node in breast cancer with large excisional biopsy". J. Am. Coll. Surg., 1999, 188, 248.

[19] Haigh P. I., Hansen N. M., Qi K., Giuliano A. E.: "Biopsy method and excision volume do not affect success rate of subsequent sentinel lymph node dissection in breast cancer". Ann. Surg. Oncol., 2000, 7, 21.

[20] Kem K. A.: "Lymphoscintigraphic Anatomy of Sentinel Lymphatic Channels after Subareolar Injection of Technetium 99m Sulfur Colloid". J. Am. Coll. Surg., 2001, 193, 601.

[21] Derossis A. M., Fey J., Yeung H. et al.: "A trend analysis of the relative value of blue dye and isotope localization in 2,000 consecutive cases of sentinel node biopsy for breast cancer". J. Am. Coll. Surg., 2001, 193, 473.

[22] Veronesi U., P aganelli G., Viale G. et al.: "Sentinel lymph node biopsy and axillary dissection in breast cancer: results in a large series". J. Natl. Cancer Inst., 1999, 91, 368.

[23] Donahue E. J.: "Sentinel node imaging and biopsy in breast cancer patients". Am. J. Surg., 2001, 182, 426.

[24] Klauber-DeMore N., Bevilacqua J. L. B., Van Zee K. J. et al.: "Comprehensive review of the management of internal mammary lymph node metastases in breast cancer". J. Am. Coll. Surg., 2001, 193, 547.

[25] Csemi G.: "Axillary staging of breast cancer and the sentinel node". J. Clin. Pathol., 2000, 53, 733.

[26] Schrenk P.,H atzl-Griesenhodfer M.,S hamiyeh A.,W aynad W.: "Follow-up of sentinel node negative breast cancer patients without axillary lymph node dissection". J. Surg. Oneal., 2001, 77, 165.

[27] Roumen R. M., Kuijt G. P., Liem I. H., van Beek M. W.: "Treatment of 100 patients with sentinel node-negative breast cancer without further axillary dissection". Br. J. Surg., 2001, 88, 1639.

[28] Giuliano A. E., Haigh P. I., Brennan M. P. et al.: "P rospective observational study of sentinel lymphadenectomy without further axillary dissection in patients with sentinel node-negative breast cancer". J. Clin. Oncol., 2000, 18, 2553.

[29] Veronesi U., Galimberti V., Zurrida S. et al.: "Sentinel lymph node biopsy as an indicator for axillary dissection in early breast cancer". Eur. 1. Cancer, 2001, 37, 454.

[30] Chung M. A., Steinhoff M. M., Cady B.: "Clinical axillary recurrence in breast cancer patients after a negative sentinel node biopsy". Am. J. Surg., 2002, 184, 310.

[31] Chu K. U., TurnerR .R., Hansen N. M. et al.: "Do all patiients wiith sentinel node metastasis from breast carcinoma need complete axillary node dissection?". Ann. Surg., 1999, 229 (4), 536.

[32] Reynolds C., Mick R., Donohue J. H. et al.: "Sentinel lymph node biopsy with metastasis: can axillary dissection be avoided in some patients with breast cancer?". J. Clin. Oneal., 1999, 17 (6), 1720.