Sentinel node localization and biopsy in breast cancer

Currently, it is routine practice to carry out axillary lymph node dissection at the time of surgical removal of a malignant primary breast tumour. As breast cancer is being diagnosed at an earlier stage in a growing percentage of cases, this procedure is proving unnecessary in a proportion of patients. Axillary lymph node dissection carries a risk of side effects and ideally we should identify the patients who actually require the procedure. The concept of the sentinel node is not new and was developed over twenty years ago. The technique of lymphoscintography was initially used to identify the sentinel node/s in patients with malignant melanoma. A proposed alternative management strategy to routine axillary lymph node dissection in patients with breast cancer is sentinel lymph node localization using lymphoscintography and biopsy of the identified sentinel node. The aim being to accurately predict the disease status of the axilla and consequently determine whether axillary lymph node dissection is indicated. The technique is currently undergoing a multi-centre trial in the UK. During my elective at St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford I was fortunate to observe this procedure being tested, with patients undergoing both lymphoscintography and sentinel node biopsy as well as axillary lymph node dissection. The results seen during my stay were extremely encouraging.