Combination blue dye sentinel lymph node biopsy and axillary node sampling: The Edinburgh experience

AimsThe sentinel node biopsy technique which is being increasingly used to stage breast cancers has limitations regarding not being able to find the blue hot node in about 5% of cases and false negative results in 7% of cases. It has been suggested this is probably due to tumour blocking the lymphatic channels.The four node sampling technique is dependent on the surgeon's ability to find abnormal palpable nodes in the axilla without visual or radioactive signal directions. We have combined the two techniques with the expectation to improve the results.MethodThe study evaluates the combined technique in 434 patients with early breast cancer in a single centre.ResultsA blue sentinel node was identified in 394 of 434 cases (91.7%), the false negative rate was 2.4%. Thirty six patients had no sentinel node identified. Thirteen of these had positive nodes in the node sample.ConclusionAxillary node sampling adds to the accuracy of the sentinel node biopsy using blue dye. Pathological features suggest that the principal cause of false negative sentinel node biopsy is due to blocking of the lymphatic channels by the cancer.