Objectives : This study was aimed to evaluate the reliability of lymphatic mapping and sentinel lymph node
(SLN) biopsy as a modality to assess the s tutus of the raillery lymph nodal spread of early cancer breast.
Patients & Methods : The study included 36 females with TI (n=23) and T2 (n=13) breast carcinoma and
clinically no palpable axillary lymph nodes. Patients were assigned to undergo modified radical mastectomy
(Paley's Operation). lutraoperative lymphatic mapping involved peritumoral (PT) and subareolar (SA)
injection of 2-4 ml 2.5% Methylene blue dye; after 5-10 minutes the axilla was explored and blue-stained
affrretti lymphatics were traced to the lymph node for excision; all removed lymph nodes either blue-stained or
not were examined histopathologically using paraffin-section histology.
Results : All patients underwent smooth operative procedures with no intraoperat ve complications mid
successfid frill axillary clearance was achieved in all cases without impending insult to important axillary
structure. SLN were identified successfully in 30 patients (83.3%); 7 patients (19.4%) had more than one SIR
and 23 patients (63.9%) had only one SLN, while in the remaining 6 patients (16.7%) SLN were unidentifiable.
Patients with multiple SLNs had T2 tumor, while patients without identified SLNs had T1 lesions. There was
only one .false-negative SLN, thus, identification of SLN is a sure diagnostic test for the presence of metastasis
with 96.8% sensitivity, 100% specificity and positive predictive value (PPV) and an accuracy rate of 97.2%,
but its absence could exclude the presence of metastasis with a negative predictive value (NPV) of 83.3%. Using
receiver operating characteristic (ROC) curve analysis to define the test validity character of identification of
SLN as indication of axillary clearance showed that its identification is a highly specific test with area under
curve (AUC) =0.984.
Conclusion : It could be concluded that SLN biopsy enables the surgeon to assess the axillary lymph-node
status for preSence of malignant metastasis with high specificity and positive predictive value and accuracy rate
of 97.2%; thus could aid in avoidance of axillary dissection which is responsible for a certain amount of
morbidity especially in early and small sized lesions for which breast conservative surgery is appropriate |
