The role of sentinel lymph node biopsy on advising axillary lymph node dissection in breast cancer.

Objective To study the clinical value of sentinel lymph node biopsy(SLNB)to predict axillary lymph node metastasis.So advise to perform axillary lymph node dissection(ALND)in breast cancer operation or not.Methods During 2005～2008,36 cases of breast cancer patients with surgical treatment in our hospital.using technetium 99M-dextran(99M Tc-dx) 1 ml for injection around the tumor glands 2 hours before operation and 1% methylene blue 2ml(total dose) was injected into the skin of cancer location before incision using four-point method.Intraoperative sentinel lymph node biopsy,then eradication of the different ways and ALND.All SLN and non-SLN were re-sliced multi-HE staining and immunohistochemical pathological examination.Results According to intraoperative biopsy and postoperative pathologic axillary lymph node pathology,SLN detection success rate was 94.4%(34/36),SLN predict accuracy of ALN metastasis was 94.1%(32/34).Sensitivity was 85.7%(12/14),specificity was 100%(20/20),false-negative rate was 14.3%(2 / 14),the total positive and negative predictive value were 100%(12/12),and 90.9%(20/22).Compared with single slice,multi-slice HE staining and immunohistochemical examination increased the sensitivity to 92.9%(13/14),false-negative rate down to 7.14%(1 / 14).Conclusion Methylene blue method combination of radioactive tracer method can accurately detect the SLN.SLN can reflect the status of axillary lymph nodes.HE staining of multi-slice technique can reduce the false negative rate of sentinel lymph node.