Sentinel lymphadenectomy in breast cancer: identification of sentinel lymph node and detection of metastases

Abstract

Sentinel lymphadenectomy is a useful way of assessing axillary status and obviating axillary dissection in patients with node-negative breast cancer. However, controversies remain concerning the optimal method to identify the sentinel lymph node (SLN) and detect micrometastases in this lymph node. We reviewed the literature concerning sentinel lymphadenectomy in breast cancer and reached the following conclusions: (a) A combination of preoperative lymphoscintigraphy with intraoperative dye-guided and gamma probe-guided methods achieves a higher rate of identification of SLN than any of these techniques alone. (b) Immediate and reliable intraoperative assessment of sentinel node status is vital to the technique's success. However, the reliability of sentinel node diagnosis using frozen sections is questionable, because micrometastatic foci cannot always be identified. (c) Hematoxylin and eosin (H&E) staining and/or immunohistochemistry on permanent sections are useful for the detection of micrometastases in the sentinel node. Although a reverse transcriptase-polymerase chain reaction (RT-PCR) method is more sensitive than H&E staining and immunohistochemistry, it would not distinguish benign from malignant epithelial cells in the SLN. Therefore, further study is required before sentinel lymphadenectomy gains general acceptance for patients with primary breast cancer.

Sentinel Node Localization in Breast Cancer Patients Using Intradermal Dye Injection

“…Others have found similar results clearly demontrating the usefulness of immunohistochemistry (7,10,12,13). Frozen section microscopy was not used in this study but several workers have investigated the feasibility and value of frozen section microscopy (4,(9)(10)(11)(12)(13)(14).…”

Sentinel lymph node biopsy and breast cancer

“…American investigators have used 99m Tc-radiolabelled sulphur colloid 16,30,31 because 99m Tc-labelled colloidal albumin is not commercially available in the USA. In the initial studies the ideal size of the radioisotope tracer was thought to be between 10 and 200 nm 16,26,32 and so 99m Tcradiolabelled ®ltered sulphur colloid (particle size less than 200 nm) was used. However, some investigators 30,31 have suggested that un®ltered 99m Tc-labelled sulphur colloid is preferable.…”

Synthesis of a novel polyamidoamine dendrimer conjugating with alkali blue as a lymphatic tracer and study on the lymphatic targeting in vivo

“…Since Giuliano et al (1994) used 1.0% isosulfan blue (IB) for breast SLNB, doctors from different countries have tried various dyes with a view to achieve best results of SLNB. Till now, several vital dyes have been developed, like IB, patent blue (PB) (Koller et al, 1998;Noguchi et al, 1999) and methylene blue (MB). IB and PB, for a weak combination of protein will be quickly absorbed into lymph vessels after subcutaneous injection, and rarely spread to surrounding tissues.…”