Sentinel node biopsy for breast cancer: a critical analysis

Abstract The concept of sentinel node biopsy, initially introduced for melanoma, has also been used for breast cancer since the 90's, in that, with the increasingly, widespread use of mammographic screening and of other minimally invasive diagnostic procedures, smaller and smaller cancers are now being diagnosed. For these cancers axillary dissection often constitutes overtreatment. For cancers at an initial stage with a low risk of axillary metastases investigation of sentinel lymph nodes enables us the surgeon to assess the axillary lymph-node status and avoid axillary dissection which is responsible for a certain amount of morbidity. Sentinel nodes can be sought using colorimetric or radioisotope methods. To date there is no common consensus of opinion as to which is the better procedure and the respective indications. Both methods allow detection of sentinel nodes in roughly 90% of cases and the combination of the two yields 100% detection rates. It is widely accepted that sentinel node biopsy should be reserved for unifocal tumours which have not been treated previously and which measure less than 15 mm in diameter. The advantages of the procedure are substantial provided it is performed correctly by surgeons properly trained in its use. The learning curve is relatively brief and is based on no more than 30-40 cases.