ObjectiveTo investigate the incidence of nodal metastasis in a consecutive series of patients treated at the authorsrsquo; institution with highly selective criteria, and to determine the impact that lymphatic mapping and sentinel node biopsy have on the detection of nodal metastases in this carefully selected patient population.MethodsStudy patients were selected from the 7,750 breast cancer patients entered into the authorsrsquo; database from April 1989 to August 2001, based on the following criteriacolon; nonpalpable, T1a and T1b, non-high nuclear grade tumors, without lymphovascular invasion.ResultsOf the 7,750 patients in the database 1,327 (17percnt;) were found to have T1a and T1b lesions. Three hundred eighty-nine patients were confirmed to meet all four selection criteria. This represents 5percnt; (389/7,750) of the authorsrsquo; breast cancer patients and 29.3percnt; (389/1,327) of the authorsrsquo; T1a/T1b tumors. One hundred sixty patients were diagnosed before routine use of lymphatic mapping, and only one patient had a positive axillary lymph node. Two hundred twenty-nine patients underwent lymphatic mapping and sentinel lymph node biopsy, and 10 had a positive axillary lymph node. The difference in proportions of nodal positivity between the mapped and unmapped patients was significant.ConclusionsThis study clearly demonstrates the ability of lymphatic mapping and a more detailed examination of the sentinel node to increase the accuracy of axillary staging. It has been argued that this highly selected group of breast cancer patients possessing retrospectively identified ldquo;favorablerdquo; characteristics does not require axillary staging. This select population represents only 5percnt; of breast cancer patients in this series, and the authors do not believe they can be accurately identified preoperatively. Therefore, the authors strongly argue for evaluation of the axillary nodal status by lymphatic mapping.
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