Figure 4. Lymphoscintiscan (Anterior View) showing multiple "hot" sentinel lymph nodes. A: "hot" sentinel lymph nodes; B: Radioisotope injection site.

Figure 5. Modelling of nodal invasion.

Only 50 (6.2%) patients in the above study had more than 4 SLNs removed (29). Removal of three SLNs in this series identified 98.5% of node-positive patients and four SLNs identified 99.6% of the node-positive patients. Only one patient had the first positive SLN beyond this, at node number six. Removal of more than four SLNs did not appreciably increase the accuracy of finding a positive node. Similar findings were reported by McCarter et al. (30). In their series, removal of three SLNs identified 98% of node-positive patients and four SLNs identified 99%. These data suggest that for identification of "true" SLNs the surgeon can stop after sampling four nodes.

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