Sentinel node biopsy in operable breast cancer

The advent of mammography and increased awareness about breast cancer has resulted in the detection of smaller tumours. The majority of these small tumours would not have had metastasized to the axillary lymph nodes. Sentinel node biopsy (SNB) in operable breast cancer has gained popularity since it promises to avoid treatment of the axilla when the nodes are negative for metastasis. However, it has not been able to achieve its objective. The world literature quotes a false negative rate ranging from 4.7% to 12.5% on immunohistochemistry while our own results of a pilot study at the Tata Memorial Hospital (TMH) have shown a false negative rate as high as 16.6% (22.2% on frozen section). The consequence of leaving behind untreated positive non-sentinel nodes in the axilla is a potential risk for axillary recurrence. Axillary sampling is a simple and inexpensive procedure in which level I nodes are removed by a blind dissection. We have tried to critically analyze the efficacy of both the procedures, i.e. targeted sentinel node biopsy versus blind axillary sampling to see whether the latter could be a preferred alternative in terms of accuracy and cost-effectiveness in countries with limited resources.