The sentinel node procedure in XXXX : nuclear medicine as the starting point.

@entity5 @entity1 @entity0
Axillary node status is a major prognostic factor in early @entity0 . Staging with sentinel node biopsy (SNB) leads to a substantial reduction in surgical morbidity. Recent multiinstitutional studies revealed SNB false-negative rates ranging from 5.5% to 16.7%, higher than the target (<5%) set by the 2005 guidelines of the American Society of Clinical Oncology. These alarming data point to the necessity of optimization. Dual mapping with radiotracer and blue dye, combining 2 different injection sites, and routinely using lymphoscintigraphy may improve accuracy. Factors associated with decreased sensitivity, such as prior excisional biopsy or neoadjuvant chemotherapy, should be recognized. The use of SNB in situations with a high prevalence of node positivity (large @entity5 , multifocality) is controversial. The risk of missed disease after negative SNB ranges from 1% to 4% in @entity1 with T1 @entity5 and up to 15% in @entity1 with T3. With peritumoral injection, internal mammary drainage is seen in about 20% of cases. @entity1 combining internal mammary drainage with a positive axillary sentinel node have close to a 50% probability of internal mammary involvement. Lymphoscintigraphy might thus be helpful in selecting @entity1 for whom internal mammary radiation has a high benefit-to-risk ratio.
