Detection of the sentinel lymph node under local anaesthesia in early-stage breast cancer: Feasibility study in a series of 78 unselected patients

Aims: To evaluate the feasibility of excision of the sentinel lymph node under local anaesthesia in early-stage breast cancer.

Methods: Sentinel lymph node detection under local anaesthesia was carried out on all patients presenting with breast cancer at Stage T0, T1 or T2 < 3 cm and N0, M0. The lymph node was mapped using a radioisotope and patent blue dye and lymphoscintigraphy was routinely performed. No premedication was given, and local anaesthesia was carried out with xylocaine. The patients underwent tumorectomy one week later under general anaesthesia, with or without complete axillary dissection, depending on the results of the definitive histopathological examination of the sentinel lymph node.

Results: 78 patients underwent this procedure over a period of 20 months. The procedure was successful in 76 out of the 78 patients, with one failure in mapping and one failure in detection (detection rate = 97.4%). The mean time to detection was 21 min (range: 6-45). It was unnecessary to interrupt the procedure due to patient discomfort in any of the cases. One allergic reaction to patent blue dye was noted and required corticosteroid therapy without interruption of the procedure. The time to detection was correlated with the experience of the surgeon carrying of the procedure, the patient's body mass index and the number of labelled lymph nodes found at lymphoscintigraphy.

Conclusion: We have shown that it is feasible to detect the sentinel lymph node under local anaesthesia in an unselected population. Using this procedure, patients can undergo surgery with the knowledge of their axillary lymph node status while at the same time avoiding the uncertainties of an intraoperative examination of the sentinel lymph node--a source of many false negatives, particularly in the event of micrometastases.

Sentinel lymph node; Breast cancer; Local anaesthesia

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