A voluminous literature regarding SN mapping and biopsy has dealt with different methods, sites, and timing of radiotracer and blue dye injection; surgeon experience and training; and the scope and intensity of pathologic evaluation. The single most critical measure underpinning SN technology has been lymph node staging accuracy, focusing on the false-negative rate (the frequency of pathologically negative SNs when other axillary lymph nodes are positive). Schuman et al suggest refinement of the intraoperative pathologic analysis, limiting assessment to the 2 most intensely radioactive SNs plus any deemed suspicious by the surgeon. Their study sensitivity was 96%. Whereas their study is limited in patient number, there are several strengths: a consistent surgical approach, well-accepted lymphatic mapping methods and SN biopsy criteria, and exhaustive pathologic assessment. Their conclusion is that without sacrificing staging accuracy, intraoperative lymph node assessment can be performed more efficiently and with less expense.
Grant CS. Hot, Blue, Suspicious: Comment on “Processing Sentinel Nodes in Breast Cancer”. Arch Surg. 2011;146(4):393–394. doi:10.1001/archsurg.2011.28
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