Sentinel lymph node dissection for breast cancer: how many nodes are enough and which technique is optimal?

Background: Controversy exists in sentinel lymph node (SLN) mapping in breast cancer regarding the appropriate number of nodes to remove and the best technique for identification of the SLNs. Methods: A retrospective chart review from January of 1999 to January of 2004 was performed for all patients undergoing a SLN biopsy examination who had at least 1 positive SLN. Results: We identified 167 patients. A mean of 4.4 SLNs were removed per patient. All of the positive SLNs were identified by node 6. Radiotracer used alone identified 19 positive nodes (11.4%) and blue dye used alone identified 14 positive nodes (8.4%). Conclusions: Our data show that 100% of positive SLNs are found by 6 nodes removed, thereby supporting the concept that the SLN dissection may not be complete by removing only 1 or 2 nodes or only the hottest node. The use of blue dye or radiotracer alone can contribute to the overall false-negative rate. (c) 2006 Excerpta Medica Inc. All rights reserved.