When the concept of sentinel lymph node biopsy was described in patients with melanoma, researchers quickly started to use lymphatic mapping techniques in breast cancer patients in an attempt to locate the sentinel node in the axilla. We have been performing mammary lymphoscintigraphy in this role for 6 years and have now studied 159 patients. Like others, we have found that most breast cancers (93%) have lymphatic drainage that includes the axilla, and we have found an average of 1.4 axillary sentinel nodes in these patients. Surgical biopsy of the axillary sentinel nodes accurately staged the node field in 96% of patients. We have also found, however, that the pattern of lymphatic drainage from the cancer site is unpredictable; and in 49% of patients lymphatic drainage occurred across the center line of the breast to axillary or internal mammary sentinel nodes. In more than half of our patients (56%) lymphatic drainage occurred to lymph nodes outside the axilla including the internal mammary (45%), supraclavicular (13%), and interpectoral and intramammary interval nodes (12%). These nodes are also sentinel nodes, and their presence indicates that a sentinel node biopsy procedure that stages only the status of the axillary lymph nodes has the potential to understage about half the patients with breast cancer. High quality lymphoscintigraphy allows accurate mapping of peritumoral lymphatic drainage in most patients with breast cancer. It is possible that in the future accurate nodal staging in each individual will involve biopsy of all sentinel lymph nodes, regardless of their location.

FOR the treatment of lower-limb ischaemia most the superficial femoral (Boileau Grant, 1958)~ and if attention has been focused on methods of recon-healthy has a remarkable capacity for enlargement in struction or by-passing the femoropopliteal artery, the event of an obstruction developing in the superand though the importance of the profunda femoris ficial femoral (Fig. 2). Sometimes an obstruction artery in the relief of severe symptoms has not been of the latter vessel, if slow in onset, may pass unneglected, its potential is possibly not fully appre-noticed, the enlarging profunda being adequate, ciated.especially in an elderly and not very active patient. ANATOMY PATHOLOGYThe profunda is an artery of supply, as opposed to aspect of the common femoral artery, and then an artery of conduction such as the femoropopliteal.The profunda femoris artery arises from the lateral Superficial femoral artery System Profunda femoris System FIG. I .-Diagrammatic representation of profunda fernoris FIG 2.-Angiogram showing marked enlargement of rofunda fernoris artery mth dilated anastomotic channels a n 8 a large arteria collateralis magna' entering the popliteal, with superficial femoral occlusion (72-year-old male; no symptoms in this limb). artery showing sites of anastomosis with the superficial femoral and popliteal arteries.

The low local recurrence rate and high survival are consistent with published literature for early breast cancer. Changes in practice during the accrual period included improvements in histopathological reporting, a reduction in irradiation of lymph node regions, and an increase in the use of systemic therapy. These changes parallel international recommendations regarding the optimal management of early breast cancer.