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Invited Critique
June 2001

Characteristics of the Sentinel Lymph Node in Breast Cancer Predict Further Involvement of Higher-Echelon Nodes in the Axilla—Invited Critique

Arch Surg. 2001;136(6):692. doi:10.1001/archsurg.136.6.692

Kamath and associates determined that characteristics of the SLN confirm the need to complete axillary nodal staging procedures. This is the first paper that provides objective data showing that examination of the SLN with serial sectioning and cytokeratin staining will identify patients with low tumor volume. Further, the authors confirm that metastatic tumor deposits are confined to 92% of SLN evaluations.

Traditional approaches suggest that the status of the axillary lymphatic system is best determined by complete axillary LND, which has evolved from a comprehensive (level I-III; Patey) LND to the Auchincloss-Madden (levels I-II) nodal sampling technique.1 The advent of SLN mapping, championed by Giuliano et al, has more recently been confirmed to be a highly efficacious method for determining pathological regional lymph node status; the technique ensures morbidity much lower than that achieved with partial or complete axillary LND.1 The significance of this study by Kamath et al suggests that primary tumor size and tumor volume in the SLN are predictors of the incidence of non-SLN metastases in the nodal basin. Further, the method for detecting micrometastases is increasingly evident as a principle for detecting involvement of contiguous non-SLN. Thus, the present study confirms the findings of the John Wayne Cancer Center, that tumor volume in the SLN is predictive of non-SLN involvement.

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