Home    | About Us    | News & Events    | Academic Affiliates    | Contact Us    | Directions

Health Information Services Physicians Referring Physicians Hospitals and Clinics MyHealth Patients & Visitors Faculty & Staff

Ellis Fischel Cancer Center 115 Business Loop 70 W. Columbia, MO 65203 (573) 882-2100 About Clinical Trials Directions Disease Sites Ellis Fischel Gala Ellis Magazine E-mail a Patient E-mail Us Employment Gift Shop Guest House Index A to Z Make a Gift Margaret Proctor Mulligan     Breast Health Center Phone Numbers Physician Information Support Groups Treatment Programs Submit Comments

Sentinel Node Treatment (continued)

Advantages of SLN biopsy

Several advantages can be found in performing the SLN biopsy to stage the axilla. The basic theory is if the SLN does not contain metastatic disease, then the other nodes in the axilla will not contain metastatic disease. Several studies show that the SLN biopsy is accurate enough to stage the axilla. The technique now is acceptable for staging breast cancer.

This advance is significant because most early breast cancers (tumors less than 5 centimeters) do not metastasize to regional lymph nodes, and many patients who undergo an axillary dissection learn several days later that all the nodes are histologically negative. Complications of axillary dissection -- including lymphedema, arm dysesthesia and pain -- now are avoidable in many SLN biopsy patients who are found to be node-negative.

Another potential advantage of the SLN procedure is that the accuracy of nodal staging may improve. Because two SLNs are removed for each case, pathologists now can perform serial sectioning to detect micrometastatic disease. In the past, routine axillary dissections and pathologic evaluation possibly missed micrometastatic disease in some cases. If so, then pathologic understaging may have occurred, and node-negative patients actually may have had node-positive disease in the axillary contents.

Because node-positive patients are recommended to have a more intense postoperative chemotherapy regimen that may include paclitaxel, then patients whose metastatic nodal disease is missed may be undertreated. Accurate nodal staging therefore is important.

SLN biopsy also provides an opportunity to use more sensitive methods to detect nodal micrometas-tatic disease. Immunohistochemical staining for microscopic foci of metastases or molecular probing techniques such as reverse transcriptase-polymerase chain reaction may be useful in detecting occult metastases. These procedures only can be used on two to three nodes rather than with eight to 20 nodes.

If the SLN theory is correct, then ultrastaging techniques can be used. These advantages must be proved in prospective studies, but SLN biopsy can significantly reduce postoperative complications from axillary staging and potentially improve the detection of micrometastatic disease.

References

¹  Henderson IC, Berry G, Demetri C, et al. Improved disease-free (DFS) and overall survival (OS) from the addition of sequential paclitaxel (T) but not from the escalation of doxorubicin (A) dose level in the adjuvant chemotherapy of patients with node-positive primary breast cancer [abstract]. Proc Am Soc Clin Oncol. 1998;17.

²  Hsueh EC and Giuliano AE. Sentinel lymph node technique for staging of breast cancer. The Oncologist. 1998;3:165-170. Warmuth MA, Bowen G, Prosnitz LR, et al. Complications of axillary lymph node dissection for carcinoma of the breast. Cancer. 1998;83:1362-1368.

³  Cote RJ, Peterson HF, Chaiwun B, et al. Role of immunohistochemical detection of lymph-node metastases in management of breast cancer. Lancet. 1999;354:896-900.