ABSTRACT
We began to perform sentinel lymph-node biopsy for breast cancer at Memorial SloanKettering Cancer Center in September 1996, under a formal Institutional Review Board protocol in which we planned to perform a backup axillary lymph-node dissection (ALND) in our first 60 cases. Encouraged by the early experiences of Krag with isotope and Giuliano with blue dye,1,2 we modeled our initial study on that of Reintgen and Cox at the H Lee Moffitt Cancer Center,3 using a combination of isotope and blue dye in an effort to learn as much as possible about each method. Our hypothesis was that the two methods would prove complementary and would optimize results. Detailed reports of our first 60,4 first 500,5 and first 10006
procedures support that hypothesis. While a large majority of sentinel lymph nodes (SLNs) were identified by both isotope and dye (Table 23.1), about 10% were found by isotope or dye alone. Among patients with positive SLNs, we observed comparable proportions (Table 23.2), suggesting that reliance on a single technique would not have succeeded as often, and might have missed positive nodes.
