Can sentinel node biopsy avoid axillary dissection in clinically node-negative breast cancer patients?

In a consecutive series of 241 women with operable breast cancer and clinically negative axillary lymph nodes, ^99mTc was injected on the day before surgery, and scintigraphic images were taken. During breast surgery a hand-held gamma ray detector was used to locate the sentinel node and facilitate its removal separately via a small axillary incision. Complete axillary lymphadenectomy was then performed. The sentinel node accurately predicted axillary lymph node status in 232 (97.5%) of the 238 patients in whom a sentinel node was identified, and in all of the cases with a tumour <1.2 cm in diameter (38 patients). Of the 109 cases with metastatic axillary nodes, in 39 (35.8%) the only positive node was the sentinel node. In the great majority of patients, lymphoscintigraphy and gamma probe-guided surgery can locate the sentinel node in the axilla, obtaining important information on the status of axillary nodes.