BACKGROUND: The sentinel node is the first regional lymph node to receive t
umor cells that metastasize through the lymphatic channel from a primary tu
mor. The tumor status of the sentinel node should reflect the tumor status
of the entire regional node basin. Sentinel lymph node dissection (SLND) ha
s recently been investigated for use in patients with early breast carcinom
a to avoid the sequelae of complete axillary lymph node dissection (ALND).
published studies of SLND in breast cancer patients identify marked variati
ons in technique, and there are few guidelines for credentialing surgeons t
o perform SLND.
STUDY DESIGN: The purpose of this study was to assess the current practice
of SLND for breast cancer in the United States. A 27-item questionnaire was
mailed to 1,000 randomly selected Fellows of the American College of Surge
ons. Responses were anonymous. Statistical analysis was performed using SAS
software (SAS Institute, Cary, NC).
RESULTS: Response rate was 41% (n = 410), and 77% of those who responded pe
rformed SLND for breast cancer. The majority (60%) of surgeons responding r
outinely ordered preoperative lymphoscintigraphy. Of those who did lymphosc
intigraphy, 28% removed internal mammary lymph nodes when lymphoscintigraph
y showed drainage to these nodes. Ninety percent of surgeons used both blue
dye and radiocolloid. Eighty percent of centers responding performed routi
ne immunohistochemistry on sentinel lymph nodes, and 15% performed reverse
transcription polymerase chain reaction. Ninety-six percent of surgeons per
formed SLND for primary tumors 5 cm or smaller, and 95% performed SLND for
an excisional cavity 6 cm and smaller. Twenty-eight percent performed SLND
for high-grade ductal carcinoma in situ, and 28% of respondents performed 1
0 or fewer SLND procedures with subsequent ALND before performing SLND alon
e. Surgeons learned SLND through courses (35%), oncology fellowships (26%),
observation of other surgeons (31%), or were self-taught (26%),
CONCLUSIONS: The majority of surgeons in the United States use similar tech
nique for SLND breast cancer. But, there was marked variation in the number
of SLND cases validated by an ALND before performing SLND only. (J Am Coll
Surg 2001;192:453-458. (C) 2001 by the American College of Surgeons).