De schildwachtklierprocedure: standaardingreep bij de chirurgische behandeling van het mammacarcinoom

Axillary lymph node dissection may be avoided in the surgical treatment of breast cancer if the sentinel node appears to be free of metastatic tumour cells. The sentinel node concept has been validated in hundreds of patients, in whom this node has been localized successfully by dye-guided node mapping and (or) gamma-probe localization after injection of a radiopharmaceutical agent. The success rate of sentinel node localization depends on different factors, such as type, volume and injection site of the radiopharmacon, choice of the handheld gamma-probe, timing of the blue dye injection, and clinical stage of the disease. The combination of preoperative lymphoscintigraphy, intraoperative gamma-probe guidance and blue dye administration will increase the success rate of a sentinel node biopsy. Recent reports, from both Europe and the United States, appear to indicate that the sentinel node biopsy will soon be standard procedure in the surgical treatment of (T1-2) breast cancer. In the majority of breast cancer patients axillary lymph node dissection, a cause of much morbidity, may thus be avoided.