Mapping a Pathway for Axillary Staging

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Abstract
IN 1972, Haagensen1 illustrated the axillary nodal uptake of a vital blue dye during mastectomy. In 1977 Cabanas2 described the identification of nodal drainage pathways and a sentinel node (SN) from penile cancer. Fifteen years later, at the John Wayne Cancer Institute in Santa Monica, Calif, Morton et al3 introduced intraoperative lymphatic mapping as a minimally invasive, practical means of identifying regional nodal metastases to eliminate routine lymph node dissection in patients with no evidence of metastases from cutaneous melanoma. Our group at the John Wayne Cancer Institute popularized the concept of an SN as the first regional lymph node to receive tumor cells that metastasize along the lymphatic drainage pathway from a primary tumor. The tumor status of this SN should therefore reflect the tumor status of the entire regional lymphatic drainage basin.