RT Journal Article SR Electronic T1 The Sentinel Node Procedure in Breast Cancer: Nuclear Medicine as the Starting Point JF Journal of Nuclear Medicine JO J Nucl Med FD Society of Nuclear Medicine SP 405 OP 414 DO 10.2967/jnumed.110.081711 VO 52 IS 3 A1 Elif HindiƩ A1 David Groheux A1 Isabelle Brenot-Rossi A1 Domenico Rubello A1 Jean-Luc Moretti A1 Marc EspiƩ YR 2011 UL http://jnm.snmjournals.org/content/52/3/405.abstract AB Axillary node status is a major prognostic factor in early breast cancer. 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 tumor, multifocality) is controversial. The risk of missed disease after negative SNB ranges from 1% to 4% in patients with T1 tumor and up to 15% in patients with T3. With peritumoral injection, internal mammary drainage is seen in about 20% of cases. Patients 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 patients for whom internal mammary radiation has a high benefit-to-risk ratio.