Lymphatic Mapping and Sentinel Lymphadenectomy: Critical Review of Technique

Abstract

Histologic tumor status of axillary lymph nodes is one of the most important prognostic factors for patients with invasive breast cancer. In the past, accurate evaluation of the axillary nodes has been based on a level I and II axillary lymph node dissection (ALND), and a histopathologic evaluation of each node with a single section stained with hematoxylin and eosin. In 1994, Giuliano and colleagues described intraoperative lymphatic mapping and sentinel lymphadenectomy (LM/SL), as a more accurate and less morbid approach to evaluate the regional nodal basin [1]. The sentinel node hypothesis is predicated on the fact that there is a direct and identifiable lymphatic channel between the primary tumor and regional nodal basin. The sentinel node (SN) is the first lymph node receiving afferent lymphatic drainage from a primary tumor. Because shed tumor cells from the primary tumor may also follow this lymphatic pathway, the SN is the most likely site of regional metastatic disease, if it exists. After Morton’s [2] initial description LM/SL for cutaneous melanoma patients, over 250 LM/SL articles were published in the decade of the 1990’s. For breast cancer patients, Giuliano [3,4] popularized the blue dye technique, Krag [5] the radiocolloid technique and Albertini [6] was the first to describe a combined blue dye and radiocolloid technique. Other techniques have emerged, a subareolar injection technique [7] and an intradermal infection technique [8,9]. The purpose of the monograph is to critically review the major techniques described for LM/SL in breast cancer patients. We will focus on seminal works, comparative studies and large, multi-institutional studies