Removal of multiple sentinel lymph nodes in patients with breast cancer: defining the "correct" node.

PURPOSE: Sentinel node biopsy is routinely used for axillary staging in patients with clinical and radiological node negative breast cancer. The number of nodes removed at surgery is highly variable. A mean of 2.4 nodes is frequently seen in the larger series. Removal of multiple (3 or more) nodes does not improve the accuracy but increases both operative time and pathological analysis. The aim of the current study was to define the correct sentinel node based on uptake of blue dye and radioactive counts. METHODS: The sentinel node was identified in 121 consecutive patients using isosulfan blue dye and radioisotope. Nodes were labelled sequentially as (i) Hot (ii) Blue or (iii) Hot and Blue and submitted for pathological analysis. Data pertaining to blue dye uptake and radioisotope counts were recorded prospectively. This was correlated with pathological and scintigraphy findings. RESULTS: Thirty eight (32%) patients had a positive sentinel node. "Hot and Blue" nodes were found in 105 cases. The number of hot and blue nodes correlated exactly with the number seen on scintigraphy. "Blue" nodes were found in one case. "Hot" nodes were found in 15 cases. In cases where a "hot and blue" node was positive there were no further "hot" or "blue" nodes found to be positive. CONCLUSION: Removal of multiple sentinel nodes can be avoided by removing all hot and blue nodes and correlating with findings on lymphoscintigraphy. When present (87% of cases), the "hot and blue" node accurately predicts the pathological burden of the axilla.

Adjuvant therapies in the treatment of stage II and III malignant melanoma.

BACKGROUND: The incidence of cutaneous melanoma has increased during the past three decades. The development of sentinel lymph node biopsy has facilitated better staging. Despite these improvements, 5-year survival rates for American Joint Committee on Cancer stage II and III disease range from 50%-90%. METHODS: A review of the current literature concerning adjuvant therapies in patients with stage II and III malignant melanomas was undertaken. RESULTS: The focus of adjuvant therapies has shifted from radiotherapy, BCG and levamisole to newer biological agents. Interferon, interleukin and vaccines have been evaluated but none of these agents have demonstrated an increase in overall survival in patients with stage II and III melanoma. Interferon can prolong disease-free interval. CONCLUSION: At present, no adjuvant therapy improves overall survival in patients with stage II and III melanoma. New staging allows more accurate stratification of patients for clinical trials.