I find it interesting that Dr Cody criticizes most of the assumptions of our article, yet agrees with its conclusion that surgeons should perform full axillary dissection until they have ascended the "learning curve" for sentinel node biopsy. Hopefully, I can mollify some of Cody's concerns.
Failure to Identify Sentinel Nodes. At the time our article1 was submitted, the 17 published studies (Table 1 in our article) included only 9 (53%) in which sentinel nodes were identified in 90% or more patients. These series included the surgeons' early and later operative experience. Only 6 of these series listed 50 or fewer patients, and in those 6, sentinel nodes were identified 66% to 92% of the time (weighted average, 86%). I suspect that the occasional operator, especially in institutions without good nuclear medicine support, will perform at a level closer to the early experience cited in our article (references 5 and 7) than the later publications described by Cody. A recent publication from a multidisciplinary breast center (with good support) noted that the sentinel node was identified in 73% of their first 44 cases.2