Breast cancer is the most common malignancy among women worldwide. In India breast cancer is fast emerging as the leading cancer among women, replacing cervical cancer in majority of the population-based cancer registries. During the last three decades due to widespread use of screening mammography in the western world a large number of node negative, early breast cancers are being diagnosed with increasing frequency. In the early 90s to avoid the morbidity of axillary lymph node dissection (ALND) sentinel lymph node biopsy (SLNB) has been proposed as minimally invasive alternative for surgical staging of clinically node negative early breast cancer patients. Currently SLNB is being advocated as standard of care in the western worldbased on the scientifi c evidence generated by a number of single institutional and multicentre international trials. In the recent past, the concept of SLNB is slowly catching-up in India. However, the western experience and guidelines cannot be directly extrapolated to the Indian scenario without addressing the issues pertaining to the patient profi le, availability of expertise, training, quality control and cost factors.The Indian experience in SLNB is limited with a small number of published validation studies. Parmar et al. [1] reported results of a validation study from Tata Memorial Hospital in 2003. In this study 100 node negative early breast cancer patients had a SLNB mapping using blue dye. Sentinel lymph node was identifi ed in 77% of patients COMMENTARY with a false negative rate of 22.2% using frozen section and 16.6% using immunohistochemistry. The authors have also reported a 36.7% false negative rate for clinical assessment of axilla. Another validation study was performed at All India Institute of Medical Sciences (AIIMS) by Deo et al. [2]. Between 2000 and 2002, 76 node negative early breast cancer patients had a SLNB using blue dye. In this study, intraoperative imprint cytology was used for evaluation of sentinel node. The SLN identifi cation rate was 90.4% and the sensitivity, specifi city and accuracy of SLNB in predicting axillary node status was 84.2%, 100% and 91.3%, respectively with a false negative rate of 8%. The sensitivity, specifi city and accuracy of intaoperative imprint cytology was 96.9%, 100% and 98.6%, respectively. In another study from AIIMS, Bassi et al. [3] reported 100% sentinel node identifi cation rate, 90.9% negative predictive value and 10.5% false negative rate in 40 breast cancer patients using combined blue dye and radiotracer technique. In 2008, Somsekhar et al. [4] reported their preliminary experience of SLNB in 100 early breast cancer patients from Manipal Hospital, Bangalore using combined blue dye and radiotracer technique. They reported a 100% SLN identifi cation rate with 96% sensitivity and 100% specifi city, and 3.7% false negative rate.As far as the disease spectrum of breast cancer is concerned there is a big disparity between western and Indian breast cancer patient profi le. Majority of the patients in India present wit...
