Sentinel Lymph Node Biopsy in Patients with Breast Cancer

The term “sentinel node” was first used by Gould et al. in 1960 to describe the first node in the drainage pathway of a malignant tumor (1). In 1977, Cabanas proposed that sentinel lymph nodes could be removed and evaluated to determine the need for complete lymph node dissection in penile carcinoma (2). Landmark studies by Norman et al. in the early 1990’s redefined Sappey’s line physiologically and demonstrated the necessity of lymphoscintigraphy to accurately assess nodal basins in truncal and head and neck melanoma (3),(4). Morton and colleagues then observed that preoperative lymphoscintigraphy demonstrated a single lymph node receiving drainage from the primary melanoma (5),(6). Alex et al. and Krag et al. reported the use of a handheld gamma probe to identify sentinel lymph nodes following lymphoscintigraphy in both melanoma and breast cancer patients (7),(8). Giuliano demonstrated that blue dye accurately identified the sentinel lymph node in 174 breast cancer patients (9),(10). The early sentinel node mapping experience using single agents was associated with 65% to 70% accuracy rates (7)–(9), and in 1996 Albertini et al. described a combination technique that improved the success rate of sentinel node localization to 92% (11).