Javeria Iqbal, Syed Zahid Zaidie, Ghadah M Alyahya, Bandar N Alharthi.
Sensitivity and Specifi city of Sentinel Lymph Node Biopsy in Breast Cancer: An Experience at King Fahad Medical City Riyadh.
Pak J Surg Jan ;30(2):132-5.

Introduction: Sentinel lymph node biopsy (SLNB) has become a standard diagnostic tool for axillary staging of breast cancer and has many advantages in comparison with axillary dissection. Objective: To evaluate the Sensitivity and Specifi city of Sentinel lymph node in Breast cancer patients at King Fahad Medical City. Methodology: We made a retrospective review of all sentinel lymph node procedures done in breast cancer patients, at KFMC over the last 5 years from March 2009 to September 2012. Patients with established diagnosis of breast cancer were admitt ed day before surgery aft er obtaining informed consent. Th e nuclear tracer nanocolloid (Human albumin colloidal particles 0.5mg/viol) was injected an hour before surgery at the nuclear department of KFMC, in a sub dermal periareolar position. 10cc of methylene blue (Patent Blue V) was then injected aft er intubation of the patient in a subcuticular periareolar position followed by 5-10 minutes of local massage. Th e nuclear probe was then used to locate the area of maximum activity. An incision was given directly over the site of maximum activity and the node is dissected out and sent for frozen section. Axillary lymph node dissection (ALND) was performed depending upon the results of frozen section. Th e Mcnemars and Kappa test were used to analyze the data. Results: A total of 49 patients were included in the study. Both the mapping techniques were used in 37(75%) of the patients, while methylene blue alone was used in 8 patients and nanocolloid alone in 4 patients respectively. Among these patients the outcome of frozen section was negative in 39(79.6%) patients and positive in 10(20.4%) patients respectively. Of the total patients 20 underwent ALND during the same procedure. So we included only these patients to determine the sensitivity and specifi city of SLNB. All the patients who had SLNB negative and still underwent ALND were negative on ALND also. Among the patients who had positive SLNB 3 were negative on ALND, while 6 were positive. So the specifi city and sensitivity of the SLNB was 78.6% and 100% respectively. Conclusion: Our study showed that sentinel lymph node biopsy (SLNB) is a highly Sensitive and Specifi c in determining Axillary nodal involvement and should be used in patients with breast cancer before proceeding to ALND.

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