Deep axillary sentinel node1/21/2024 ![]() ![]() ![]() In that case, there is no additional diagnostic value in dissecting more SNs before the axillary dissection. Once a positive node is identified, standard axillary dissection is routinely performed. It is, therefore, common practice to continue dissecting lymph nodes until the counts are less than 10% of the hottest node.Ī better understanding of the diagnostic value of multiple SNs dissection is, however, of primary importance to minimize operating time and possible morbidity and to decrease cost. Previous studies 13, 14 have demonstrated that the first encountered node is not necessarily the hottest node and that cancer cells might be found in the second or third to the hottest node. The commonly accepted way to measure the radioactivity has been to perform a 10-second radioactivity count ex vivo after the lymph node is removed from the surgical field. 12 This definition is, however, not so simple for radioactive “hot” nodes, where different amounts of radioactivity might be present in different lymph nodes. Any lymph node with blue color in it or in a lymphatic entering it is considered an SN. The blue dye defines an SN in a rather simple way. It has been shown previously 10, 11 that more than 1 SN is commonly found in the axilla. Sometimes, cytokeratin stains are added to increase the detection rate.This tedious examination allows the identification of micrometastases in the SNs and leads to upstaging of approximately 9% to 10% of them. The lymph nodes primarily draining the injection site are identified in the axilla by the blue color and the radioactive signal recorded using a small detecting probe.Īfter SNs are removed, the pathologist performs multiple sections on each node looking for metastatic disease. ![]() 1 - 5 In this procedure, a radioactive tracer, a blue dye, or both are injected around the tumor. This allows the axilla to be staged more accurately without the morbidity of a full axillary dissection. Sentinel lymph node (SN) biopsy has gained acceptance in the stratified therapeutic approach to breast cancer. Additional radioactive SNs should be processed only in the presence of nodal disease. On the basis of all 105 patients, consideration of nonradioactive blue axillary nodes did not add significant diagnostic value relative to testing only radioactive nodes: sensitivity of 86.7% vs 88.6% ( P = .50), whereas consideration of all hot, blue, and suspicious nodes improved sensitivity to 96.2% ( P = .002).Ĭonclusions Processing of the 2 hottest nodes, along with suspicious but nonhot and nonblue nodes, is sufficient for initial axillary staging. Examination of all other radioactive nodes did not diagnose any additional cases. Consideration of the 2 most intense axillary nodes was sufficient to diagnose nodal disease in an additional 12 patients, representing a significant increase in sensitivity to 90.4% ( P < .001). An analysis of the 282 radioactive axillary nodes for which the 10-second count was recorded reveals that the most radioactive node was positive in 73 of 94 analyzable patients (77.7%). Results Three hundred fifty-three axillary SNs were recorded in the database. Main Outcome Measures The diagnostic value of SNs by analyzing the sensitivity of processing the hottest, 2 hottest, hot and blue, or hot, blue, and suspicious SNs. Patients One hundred five patients with node-positive breast cancer who underwent SN biopsy. Objectives To analyze a series of sentinel nodes (SNs) from patients with node-positive breast cancer to determine their diagnostic value, to delineate a working algorithm, and to assess the clinical value of our common practiceĭesign A prospectively collected database. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography. ![]()
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