This document discusses the sentinel lymph node concept in early breast cancer. It presents three case studies of patients who underwent segmentectomy or breast-conserving therapy along with sentinel lymph node biopsy for early-stage breast cancer tumors. The sentinel lymph node biopsy procedure involves injecting radioactive tracing agents and blue dye to identify the first draining lymph node from the tumor, which is then biopsied to detect any cancer metastases. The sentinel lymph node biopsy procedure provides accurate assessment of axillary node status while avoiding unnecessary full axillary lymph node dissection for most early-stage breast cancer patients.

1. Sentinel Lymph node concept in
Early breast cancer
BY: PROF. R.W.WASIKE
MB CHB, MMED(UoN) FRCS(C)
Associate Professor
Consultant General /Breast Surgeon
Department of Surgery
Aga Khan University Hospital, Nairobi

2. Case One
A 50 years old female patient
A 2cm lump – core biopsy invasive ductal carcinoma
of the breast grade I (ROUQ
Segmentectomy with sentinel lymph node biopsy –
negative
ER/PR – negative
Radiotherapy given
Has recovered well

5. Case Two
A 40-year-old female presented
with 2.5cm lump in LLOQ.
•No axillary lymphadenopathy
•Core biopsy invasive ductal
carcinoma
•Done BCT/sentinel negative
lymph biopsy
Given
•Radiotherapy
•Chemotherapy due to age and
grade of tumour

6. Case Three
A 45-year old female
presented with 1cm lump in
the ROUQ
•No lymphadenopathy
•Core biopsy
•Grade I invasive ductal
carcinoma
•Done BCT/SLNB (-ve)
Given
•Radiotherapy and Tamoxifen
– ER/PR positive

7. B C T / S L N B..105 MASTECTOMY/S L N B..68
STAGE O 30
STAGE 1 60
T2 TUMOURS 83
KEY:
BCT:- Breast Conservation Therapy
SLNB:- Sentinel Lymph Node Biopsy

8. False negative rate 6%
Positive Predictive value 96%

9. Lymphatic drainage of the breast

10. Management of Axillary Lymph Nodes
•Infitrating ductal cell carcinoma (IDCA)
•Invasion of tumor cells beyond the basement
Membrane
•Nodal basin needs evaluation
• Gold Standard
•Complete ALND
•Sentinel Node Biopsy (SLNB)
•Early breast cancer

11. Axillary Node Dissection
•Staging:
•Single best predictor for risk of systemic
disease and cancer recurrence
•Therapeutic decisions
• Systemic therapy
• Radiation therapy
•May improve survival and cure

12. Sentinel Lymph Node Biopsy (SLNB)
•Definition
•“gate-keeper” or first echelon node to drain a tumor,i.e. primary
breast cancer
•Focuses on
• Identify node-negative patients
•avoid unnecessary node dissection
•Identify node-positive patients
•Complete node dissection
•Systemic therapy
• XRT

13. The navigator sentinel probe
Smart.
Simple.
Precise.

15. Mapping the sentinel node
Surgical procedure performed to locate, excise and
pathologically evaluate the Sentinel Lymph Node.
Used for breast tumors or melanoma
Sentinel Lymph Node (SLN) is the first lymph node
receiving lymphatic drainage from the tumor
Navigator used in conjunction with a
radiocolloid(Tc99) and Lymphazurin blue dye to
locate the SLN
SLN biopsied to determine metastases

17. Identifying the sentinel node
Node basin re-examined for secondary, tertiary
SLN’s – 10% Rule
SLN(‘s) sent to pathology to see if positive for
metastases
Incision closed after pathology report

19. Identifying the Sentinel Node
•Injection material
•Technetium-99m sulfur colloid
• Isosulfan blue
•Site of injection
•Intra-tumoral
•Intra-parenchymal
•Intra-dermal/peri-areolar
•Embryological: axilla
•May miss internal mammary nodes

21. European Institute of Oncology
1998 – 1999 (516 patients)
Axillary Dissection Sentinel lymph-node
Biopsy
Dissection if the sentinel
node is positive

22. Overall Survival

23. IEO 2001
SN with Micrometastases <2mm
931
cases
Axillary
Dissecti
on
NO
Axillary
Dissectio
n

24. IEO 2001
Galimberti V, et al. 2013

25. New IEO Trial
(in progress)
T1 NO
Without clinical and ultrasound evidence of suspicious axillary
nodes
Sentinel Node
Biopsy
No Axillary
treatment

27. Interpretive Summary
SLNB for early breast cancer is relatively a new procedure.
SLNB is acceptably accurate assessment of the axillary status.
The role of routine IHC and/or molecular biological analysis of SLNB
remains unclear.
Appropriately identified patients, successfully mapped, with a
negative SLNB do not require a level I or II ALND.
Gary H. Lyman et al Journal of Clinical Oncology 2005

28. Questions ????