Axillary Dissection Is Not Required for All Patients With Breast Cancer and Positive Sentinel Nodes

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Abstract
THE APPLICATION of Cabanas'1 concept of the "sentinel node"(SN) to malignant melanoma by Morton et al2 in 1992 greatly increased the sensitivity of surgical staging and provided a basis for omitting routine lymphadenectomies when the SN is tumor free. This practice substantially reduces the number of patients undergoing complete lymph node dissections, which avoids the possible complication of lymphedema. Use of isosulfan blue dye and, later, radioisotopes for audiovisual identification of the node(s) most likely to contain metastatic disease has revolutionized the treatment of melanoma. In a similar fashion, the adaptation of lymphatic mapping and SN biopsy for breast cancer staging by Giuliano et al3 and Krag et al4 has been one of the most significant surgical innovations of the last decade and has revolutionized the approach to treatment of breast cancer. Sentinel node biopsy for breast cancer has repeatedly and reproducibly been proven to increase the sensitivity of surgical staging through the discovery of microscopic or even cellular metastases missed on routine pathologic review.3-5