Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of General Surgery

Axillary lymph node dissection (ALND) has been regarded for most of the 20th century as the 2gold standard3 operation to achieve these goals, but has largely been replaced over the past decade by sentinel lymph node (SLN) biopsy, first reported by Krag et al. in 1993 and Giuliano et al. in 1994 which allows the avoidance of ALND in SLN negative patients, sparing them the morbidity of a larger operation (eg: lymphedema , sensory loss, nerve injury, shoulder dysfunction) and the staging accuracy is at least equivalent. The sentinel lymph node (SLN) is the gatekeeper of the lymphatic basin; it is the first node to receive lymphatic drainage of the tumor. In theory, if the SLN does not involve metastases, the other lymph nodes are also negative. Accepting the accuracy of this theory prevents unnecessary axillary dissection. Today, there are two different methods used for SLN determination, including the use of a surgical gamma probe by preoperative lymphoscintigraphy and lymphatic mapping using blue dyes . However, a combined use of these two methods has yielded more successful results

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