Dye-guided sentinel lymphadenectomy in clinically node-negative and node-positive breast cancer patients

Background: Sentinel lymphadenectomy has been used to assess the axillary nodal status in patients with breast cancer in an attempt to avoid unnecessary axillary dissection. Most studies have examined the utility of this procedure in clinically node-negative patients. However, the clinical evaluation of axillary nodes is often inaccurate for both clinically node-negative and clinically node-positive patients. Methods: We performed dye-guided sentinel lymphadenectomy in both clinically node-negative and clinically node-positive patients with breast cancer. All patients also underwent a formal axillary dissection. The results of imprint cytology, frozen sections, and permanent sections of the sentinel lymph node (SLN) were compared with each other and with histologic findings of the nonsentinel nodes. Results: The SLN was identified in 30 (79%) of 38 patients with clinically negative nodes, and in 11 (92%) of 12 patients with clinically positive nodes. For clinically node-negative patients, SLN evaluation yielded a diagnostic accuracy of 90%, a sensitivitiy of 72%, and a specificity of 100%. For clinically node-positive patients, these values were 100%, 100% and 100%, respectively. These values were not significantly different for the two groups of patients. Conclusions: Sentinel lymphadenectomy may be useful in assessing the axillary nodal status of both clinically node-positive and clinically node-negative breast cancer patients.