Sentinel Lymphadenectomy – Ready for Clinical Routine?

mostly all medical fields is the individualization of therapy guided by the individual needs of each patient. Beside new techniques for molecular diagnostics, the sentinel lymph node biopsy (SLNB) is one of the approaches to the individualization of surgical therapy and, moreover, to individualized multimodality treatment. The node that has the highest probability of tumor infiltration and, thus, reflects the nodal status of the adjacent lymph node region is called the sentinel lymph node (SLN). Instead of a systematic lymph node dissection a selective SLNB reveals the nodal status of the lymph node region. The major goal is the selection of patients with a tumor-infiltrated SLN for lymph node dissection of the corresponding lymph node region, whereas in nodal-negative patients, trauma, costs and morbidity of the dissection can be avoided. After 7 years of continuous, controlled evaluation it has become obvious that the method is a safe and practicable way to determine the axillary nodal status in patients with small breast cancer and clinically negative lymph nodes. Detection rates of more than 90% and an accuracy in the prediction of the nodal status of 95–100%, controlled by a complete axillary lymph node dissection (ALND) subsequent to SLNB, were described after a relatively short period of training [1–3]. Moreover, after selective histopathologic evaluation using more serial sections and immunohistochemical staining, the rate of nodal-positive patients could be increased by the detection of micrometastases in about 10% of the cases [4]. The convincing results have led to widespread routine use of the SLNB in experienced centers of the USA [5], whereas in Europe, large, randomized, long-term controlled studies to compare the results of SLNB with complete systematic dissection are currently undertaken or still in preparation. Aims of these studies are: (1) to prove that, even in clinical practice, the false-negative rate (rate of patients falsely determined as nodal-negative) of the SLNB does not lead to a worse clinical outcome; (2) to prove that the morbidity after SLNB in nodal-negative patients is lower than in patients with complete node dissection (ALND). However, if we are aware of more than 100 published studies demonstrating excellent detection rates and a very high accuEditorial