Clinical Significance of Micrometastatic Disease in the Era of Sentinel Node

Abstract

The 1990’s ushered in a new era of staging the regional lymph node basin for patients with cutaneous melanoma and invasive breast cancer. At the 1990 meeting of the Society of Surgical Oncology [1], intraoperative lymphatic mapping and sentinel lymphadenectomy (LM/SL) with isosulfan blue dye (Lymphazurin 1%, Hirsch Industries, Inc., Richmond, VA) was proposed as an accurate alternative to routine elective lymph node dissection for staging the regional lymphatics in patients with cutaneous melanoma [2]. At the 1994 meeting of the American Surgical Association (Giuliano AE, Kirgan DM, Guenther JM, Morton DL. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Presented at The American Surgical Association, San Antonio, TX, April 7-9 1994), LM/SL with isosulfan blue dye was proposed as an accurate alternative to routine level I and II axillary lymph node dissection (ALND) in patients with invasive breast cancer [3]. Other investigators [4–7] have proposed using radioactive technetium-labeled sulfur colloid to identify the sentinel node for melanoma [8] and breast cancer patients [9,10]. A mounting body of evidence suggests that a combination of the two methods maximizes the accuracy rate for identifying the sentinel node [11–14]. This paper does