Extra-axillary sentinel node biopsy in breast cancer staging—is it necessary?

Aims: The aim of this study was to assess the value of lymphoscintigraphy in general and extra-axillary lymph node biopsy in particular, based on our experience with sentinel biopsy in 128 consecutive woman undergoing surgery for breast cancer. Methods: Sentinel node biopsy was performed with the aid of isotope, hand held gamma probe, blue dye and lymphoscintigraphy in 83 patients. Injection technique was peritumoral or intratumoral. Lymphoscintigraphy was performed 2–4 h following isotope injection. Results: Eighteen lymposcintigraphies were negative (21.7%). The sentinel node was found in 14 of these cases. We were unable to identify the sentinel node(s) in four patients (4/83; 4.8%). All in all 20/25 (80%) extra-axillary nodes were located and taken out. Only two of these (2/20, 10%) were positive for metastatic disease on histological examination. The adjuvant treatment plans for these patients were not altered in response to these findings. No positive extra-axillary node(s) with simultaneous normal axillary sentinel node was found. Conclusions: In this serie, lymphoscintigraphy and biopsy of extra-axillary sentinel nodes added nothing but time, risk and cost to the procedure.