Current status of sentinel lymphadenectomy in breast cancer.

Investigators at many cancer centers have verified that the sentinel node (SN) is the first lymph node to receive lymphatic drainage from a primary breast cancer and therefore the node most likely to contain metastatic tumor cells. When sentinel lymph node dissection (SLND) is undertaken by an experienced multidisciplinary team, the finding of a tumor-free SN almost invariably indicates that the patient has node-negative breast cancer and need not undergo further axillary dissection. At the present time, however, only centers with experience in SLND may abandon completion axillary lymphadenectomy when the SN is free of tumor. In other settings, level I and II axillary dissection is essential until the SLND team has achieved consistently accurate results and the institution has established excellent quality control.