Early experience of sentinel lymph node biopsy in breast cancer

ABSTRACT

To assess the results of sentinel lymph node biopsy in breast cancer. Case Series. Surgical Ward 3, Jinnah Postgraduate Medical Centre Karachi, from April 2007 to March 2009. In this study patients with biopsy proven carcinoma breast and clinically negative lymph nodes in the axilla were included. Patients with history of previous breast surgery, clinically palpable lymph nodes, Stage IV disease, bleeding disorders, chronic liver disease or history of allergic reaction to the dye were excluded. The study patients underwent sentinel lymph node mapping and dissection. One ml of gentian violet or methylene blue dye injected into the peritumoral area followed by one minute massage. Simple mastectomy or wide excision with axillary clearance was done after 30 minutes of injection. This study was conducted on 35 patients with the age range from 28 years to 68 years. In all the patients diagnosis was infiltrating ductal carcinoma. Wide local excision with axillary clearance was possible in only two patients with clinically stage 1 disease. In rest of the patients simple mastectomy with axillary clearance was done. According to the tumor size; T1 was observed in 15 patients, 72 in nine, T3 in six and T4 in five patients. In all patients [n 15] with T1 tumor, stained lymph node was positive in eight patients while tumor metastasis in the remaining lymph nodes removed by axillary clearance showed involvement in six patients. In patients with T2 masses, tumor involvement was seen in both groups of lymph nodes in six patients. In three patients with T4 tumor, sentinel lymph nodes were negative for tumor metastasis however in rest of the lymph nodes tumor involvement was seen in four patients. In patients with T3 masses, three showed involvement of the entire axillary lymph node group and sentinel lymmph node as well. If sentinel lymphnode is involved by the tumor, axillary clearance should be done irrespective of the tumor size. Sentinal node biopsy should be avoided in patients with T4 lesions