Can sentinel node biopsy avoid axillary dissection in clinically node-negative breast cancer patients?

In a consecutive series of 241 women with operable breast cancer and clinically negative axillary lymph nodes, 99mTc was injected on the day before surgery, and scintigraphic images were taken. During breast surgery a handheld gamma ray detector was used to locate the sentinel node and facilitate its removal separately via a small axillary incision. Complete axillary lymphadenectomy was then performed. The sentinel node accurately predicted axillary lymph node status in 232 (97.5%) of the 238 patients in whom a sentinel node was identified, and in all of the cases with a tumour <1.2 cm in diameter (38 patients). Of the 109 cases with metastatic axillary nodes, in 39 (35.8%) the only positive node was the sentinel node. In the great majority of patients, lymphoscintigraphy and gamma probe-guided surgery can locate the sentinel node in the axilla, obtaining important information on the status of axillary nodes.