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Differential staining of collagens and non-collagens with Coomassie Brilliant Blue G and R.

The following proteins were subjected to electrophoresis in SDS gels and stained with both Coomassie Brilliant Blue R and Coomassie Brilliant Blue G: the pepsin-treated collagen types I, II, III and V, and non-pepsin-treated type IV collagen, and the non-collagens, laminin, fibronectin, myosin, beta-galactosidase, fibrin, phosphorylase b and serum albumin. The Coomassie Brilliant Blue G stain was formulated as in the dye-binding protein assay reagent of Bradford (Anal. Biochem. 72: 248-254, 1976). Coomassie Brilliant Blue R prominently stained all polypeptides, but the collagen chains, including the type IV chains, stained metachromatically (red or pink) while the non-collagens stained orthochromatically (blue-violet). In the Bradford reagent, however, only the non-collagens and the intact type IV chains were prominently stained; the pepsin-treated collagen chains were virtually undetectable provided that detergent had been exhaustively removed prior to immersion in the stain. Metachromatic staining with Coomassie Brilliant Blue R is attributed to the presence of closely-spaced proline and hydroxyproline residues in sequences from triple-helical domains. The staining of type IV chains with the Bradford reagent is attributed to the presence of binding sites in the sequences from the non-triple-helical domains only, since such binding sites are absent from chains derived from the pepsin-treated collagens.

Collagen↗

Studies on the Methyl Green-DNA complex and its dissociation by drugs.

Spectrophotometric results indicated that Methyl Green bound stably to native calf thymus DNA and to poly[d(A-T)] but to a lesser extent to phiX 174 DNA, tRNAs, and poly(dG-dC), a copolymer that exists preferentially in the A conformation. Exposing the Methyl Green-DNA complex to graded concentrations of ethyl alcohol liberated part of the dye slowly by a zero-order reaction; higher alcohol concentrations which cause the B leads to A transition of DNA released the bulk of Methyl Green. The viscosity of the Methyl Green-DNA complex was significantly lower than that of the uncomplexed DNA. The dye was progressively liberated from DNA by 1.5 x 10(-1) M NaCl and by much lower concentrations of Mg2+; in its stoichiometric complex with DNA, it increased Tm by approximately 12 degrees C. A series of DNA-complexing drugs displaced Methyl Green from DNA at exponential rates and to end points which were correlated. End points of displacement correlated with the abilities of drugs to unwind supercoiled DNA, to labilize ribosomes to heat, and to eliminate a kanamycin resistance determinant from an R factor carried by Salmonella typhimurium. Additional correlations between Methyl Green displacement and biochemical-biological activities of displacing drugs are cited. In conjunction with these findings, our results suggest that Methyl Green displacement analysis is a useful biochemical screen for the detection or development of biologically active compounds which bind to DNA.

Animals↗

[Identification of axillary sentinel node by lymphotropic dye in breast cancer. Feasibility study apropos of 128 cases].

AIM OF THE STUDY: The goal of this study was to evaluate the technical feasibility of sentinel node biopsy in breast cancer and its predictivity of axillary node status. PATIENTS AND METHODS: Between January 1996 and June 1997, 128 patients with invasive breast carcinomas, referred to the Cancer Center of Strasbourg and Lyon (France), underwent lymphatic mapping (Patent Blue dye) and sentinel node biopsy followed by axillary clearance (Berg's level I to II). RESULTS: Sentinel node was identified in 76.5% of cases and was predictive of axillary status in 94.9% of cases. The false negative rate of the procedure was 5.1%. Sentinel lymph node was involved in 43.9% of cases and it was the only one involved in 30.2% of cases. The sensitivity of the procedure was 94% (CI: 95% = [88%-98%]) and its specificity 100%. CONCLUSION: Actually considered as new attractive procedure under ongoing evaluation in prospective controlled trials, this study confirms the feasibility and reproductibility of lymphatic mapping and sentinel node biopsy, first stage before entering a new era of minimally invasive axillary surgery in breast cancer.

Adult↗

Chromophore-assisted laser inactivation (CALI) to elucidate cellular mechanisms of cancer.

Chromophore-assisted laser inactivation (CALI) is a new technology for acute protein inactivation in living cells. It targets laser energy to specific proteins via non-function-blocking antibodies that are labeled with the dye malachite green. Excitation of the dye generates short-lived free radicals that damage the bound protein without affecting other cellular components. The wavelength of laser light used (620 nm) is not readily absorbed by cells such that non-specific light damage does not occur. CALI provides an alternative to other inactivation strategies and has the advantages of high spatial and temporal resolution. The ultimate value of this technology for cancer research will be assessed by how effective CALI is in ascribing in situ function during cancer-relevant processes and in identifying and validating protein targets for drug discovery. Recent work using CALI on ezrin and pp60-c-src, two proteins that may be involved in cancer, suggests its potential. Further application of CALI will likely be of utility for understanding cellular mechanisms of cancer and developing cancer therapeutics.

Animals↗

On Schiff's bases and aldehyde-fuchsin: a review from H. Schiff to R. D. Lillie.

In histochemistry aldehyde-fuchsin is widely regarded as an azomethine compound, though this hypothesis cannot explain the variety of reaction products. Infrared spectroscopy did not show a C = N bond. It was therefore deemed of interest to review chemical studies of aldehyde-fuchsin and other Schiff's bases by Schiff and his contemporaries. Schiff regarded reaction products of low molecular aliphatic aldehydes, e.g. acetaldehyde, and aromatic amines as diarylamines; aldehyde-fuchsin was assigned a 2:3 (dye:aldehyde) formula. These reactions were facilitated by alcohol and HCl. Others suggested condensation of two aldehyde molecules which carried a secondary and a tertiary amine respectively. Eibner proved that these compounds were ethylenes, not azomethines, and contained two secondary amines. Condensation of such bases produced ethylenic polymers, the Schultz's bases. Aromatic aldehydes readily yielded azomethines; aliphatic aldehydes formed --C = N-- bonds only during prolonged heating. These findings are in agreement with recent chemical data. Clearly, the term Schiff's bases is not synonymous with azomethines, but denotes any reaction product of aldehydes and amines. In 1962, Lillie's histochemical studies confirmed "the secondary amine nature of aldehyde aryl amine condensation". Thus, chemical and histochemical studies from Schiff in the 1860's to Lillie in the 1960's indicate that aldehyde-fuchsin is not an azomethine compound, but contains diarylamines and their derivatives.

Aldehydes↗

Prospective evaluation of factors influencing success rates of sentinel node biopsy in 814 breast cancer patients.

OBJECTIVE: This prospective multicenter study was performed to assess the reliability of sentinel lymph node (SLN) biopsy in breast cancer and to analyze factors potentially influencing success rates. METHODS: In 21 departments, SLN biopsy and consecutive axillary lymph node dissection were performed in 814 breast cancer patients. The 80 surgeons involved were free in the choice of lymphography technique. The detection rate and the sensitivity, as well as the impact of lymphography technique, patient selection, technical procedure and learning curves, were evaluated. RESULTS: The blue dye technique was used in 137 patients, radiocolloid in 169 patients, and combined blue dye/radiocolloid in 508 patients. The identification rate for the sentinel node was 83.9% for the entire group and showed a significant dependence on the lymphography technique (blue dye, 71.6%; radiocolloid, 78.8%; combined blue dye and radiocolloid, 89.6%). The overall sensitivity in detecting lymph node metastases was 91.3%. Immunostaining for cytoceratine revealed micrometastases in 19 (5.1%) of 374 patients in whom H/E staining was negative. The combined subdermal/peritumoral injection of the colloid showed a significantly higher identification rate than subdermal or peritumoral injection alone (96.8%, 84.6%, 78.6%; p < 0.001). There was also a significant higher detection rate in cases of SLN biopsy performed prior to lumpectomy, compared to SLN biopsy following lumpectomy (94.7% versus 82.8%; p < 0.001). Furthermore, there was a close correlation between the number of performed examinations and the detection rate. CONCLUSION: SLN mapping predicts the axillary lymph node status accurately. Learning curves and several technical features influence the detection rate significantly. However, the false negative rate was independent of experience and injection technique.

Adult↗

Photodeactivation of ethyl violet: a potential hazard of Sodasorb.

Breathing circuit cannisters containing functional CO2 absorbent are critical to prevent rebreathing CO2 during general anesthesia using closed or semiclosed breathing systems. Ethyl violet is the indicator dye added to Sodasorb to indicate impending exhaustion of the absorbent. A case of CO2 rebreathing due to failure of ethyl violet indicator in exhausted Sodasorb was encountered. Laboratory investigation demonstrated that dye failure could result from photodeactivation caused by fluorescent lights. Using a fixed intensity fluorescent light source and quantitative spectrophotometric analysis, a highly significant dose-response relationship was demonstrated between duration of light exposure and the decrease in ethyl violet concentration. After 24 h of fluorescent light exposure with a received flux density of 46 nwatts/cm2 at 254 nm, the concentration of functional ethyl violet remaining in pulverized Sodasorb was 16% of the baseline value. Furthermore, using multiple light sources of various intensities, the greater the intensity of light, the more rapid the rate of decline of the ethyl violet concentration. It is recommended to minimize the problem by using ultraviolet filters and incorporating additional ethyl violet in Sodasorb. Finally, ethyl violet undergoes temporal deactivation after a Sodasorb container is opened, even if it is stored in the dark.

Absorption↗

Microleakage of compomer restorations in primary teeth after preparation with bur or air abrasion.

This study compared the degree of marginal leakage of a compomer in Class V cavities of human primary molars prepared by a conventional dental bur and air abrasion with or without acid etching. Fifty-six non-carious extracted primary molars were randomly divided into four groups (n=14) to be prepared by four techniques: Group-1: Bur followed by acid etching: Class V cavity preparations were placed on the buccal surfaces of each tooth using a high-speed handpiece. The preparations were 1.5-mm deep, 3-mm long and 2-mm wide, with the occlusal margin in enamel and the cervical margin extending 0.5 mm below the cementoenamel junction. The preparations were acid etched with 37% phosphoric acid starting at the enamel margins for 30 seconds and rinsed with water for 20 seconds. The preparations were then restored with Compoglass F. 2-Group 2: Bur: The preparations and the treatment procedures were the same as in Group 1, with the exception of 37% phosphoric acid application. Group 3: Air abrasion followed by acid etching: Class V cavity preparations were placed on the buccal surfaces of each tooth using a handpiece of an air-abrasive system (PrepStart, Danville Engineering). The system was supplied with dry compressed air at 80 psi. In all tests, the air-abrasion system was operated with an 80 degrees-angle handpiece tip and 50-mm aluminum oxide particles. A tip with a 0.38-mm inner diameter was used at a 2-mm distance. The treatment procedures were the same as in Groups 1 and 2. Group 4: Air abrasion: The preparations and treatment procedures were the same as in Group 3, with the exception of 37% phosphoric acid. After finishing the restorations, the teeth were stored in distilled water at 37 degrees C for 24 hours. The samples were thermocycled for 500 cycles between 5 degrees C and 55 degrees C with a dwell time of 30 seconds. The samples were then immersed in 0.5 percent basic fuchsin dye for 24 hours at 37 degrees C. The surface-adhered dye was then rinsed in tap water and the teeth were embedded in a chemically-activated acrylic resin and bisected longitudinally in a mesiodistal direction with a low speed diamond disk. Each section was examined under a stereomicroscope (Nikon, Tokyo, Japan) at 20x magnification. The data were analyzed statistically by Kruskal-Wallis analysis of variance to determine any statistical significant differences in microleakage scores among the groups at a p-value of 0.05. Also, the enamel versus cementum-dentin microleakage scores of each group were compared using z-test at the 0.05 significance level. There was no statistically significant difference among the groups (p>0.05), but a statistical difference between enamel and cementum-dentin surfaces was evaluated (p<0.05).

Acid Etching, Dental↗

Blue native electrophoresis for isolation of membrane protein complexes in enzymatically active form.

A discontinuous electrophoretic system for the isolation of membrane proteins from acrylamide gels has been developed using equipment for sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). Coomassie dyes were introduced to induce a charge shift on the proteins and aminocaproic acid served to improve solubilization of membrane proteins. Solubilized mitochondria or extracts of heart muscle tissue, lymphoblasts, yeast, and bacteria were applied to the gels. From cells containing mitochondria, all the multiprotein complexes of the oxidative phosphorylation system were separated within one gel. The complexes were resolved into the individual polypeptides by second-dimension Tricine-SDS-PAGE or extracted without SDS for functional studies. The recovery of all respiratory chain complexes was almost quantitative. The percentage recovery of functional activity depended on the respective protein complex studied and was zero for some complexes, but almost quantitative for others. The system is especially useful for small scale purposes, e.g., separation of radioactively labeled membrane proteins, N-terminal protein sequencing, preparation of proteins for immunization, and diagnostic studies of inborn neuromuscular diseases.

Aminocaproates↗

Localization of the sentinel node of the upper outer breast quadrant in the axillary quadrants.

BACKGROUND: Sentinel node (SN) biopsy is associated with much less morbidity than axillary dissection. In patients with early breast cancer, lymphatic mapping and SN biopsy accurately stage the axillary nodes. Both currently available lymphatic mapping agents, radiocolloid and blue dye, have some limitations that may make perioperative or preoperative SN identification difficult. In such cases, exact knowledge of the topography of the axilla and the most probable location of the SN may be crucial. METHODS: In 12 fresh female cadavers with no history of breast carcinoma, injections of patent blue dye were used to visualize the SNs in the axillary quadrants and their lymphatic collectors from the upper outer quadrant of the breast, which is the most common location of breast cancer. The axilla was divided into quadrants with regard to the intersection of the thoracoepigastric vein and the third intercostobrachial nerve. RESULTS: All SNs were located within a circle of 2-cm radius of this intersection in the fatty tissue at the clavipectoral fascia. In most cases, the SN was located in the fatty tissue near the clavipectoral fascia in the lower ventral quadrant of the axilla (n = 14, 58%). In seven cases (29%), the SN was located in the upper ventral quadrant, in two cases (8%) in the upper dorsal quadrant, and in one case in the lower dorsal quadrant. CONCLUSIONS: The results of this anatomical study may facilitate SN biopsy in patients with breast cancer.

Aged↗

An assessment of the feasibility of sentinel lymph node-guided surgery for gastric cancer.

BACKGROUND: Sentinel node-guided surgery has received increasing attention in tumor surgery. To ascertain whether sentinel lymph node (SLN)-guided surgery is feasible for gastric cancers 4 cm or less in size, we conducted a multicenter clinical study. METHODS: One milliliter of isosulfan blue was injected endoscopically into the gastric wall at four sites around a gastric cancer lesion. Approximately 15 min after the injection of the dye, the surgeons resected (picked-up) the stained blue nodes (defined as SLNs) around the stomach. RESULTS: SLNs were detected in 140 of 144 patients (97.2%). The average number of SLNs was 3.3. In 99 patients with D2 lymph node dissection, the false-negative rate (FNR) was evaluated. In 14 T1 patients with pathological positive lymph node metastasis (pN(+)), the FNR was 29%. In 9 T2,3 pN(+) patients, the FNR was 44%. In T1 patients with pN(+) but macroscopically normal lymph nodes during surgery (sN0), the FNR was 11% (1/9). CONCLUSION: T1 and sN0 patients may be a target group for the study of SLN-guided surgery. A larger multicenter trial should be performed to clarify the application of sentinel node navigation surgery for gastric cancer.

Adult↗

Effects of finishing/polishing techniques on microleakage of resin-modified glass ilonomer cement restorations.

This study investigated the effect of finishing/polishing techniques on the microleakage of resin-modified glass ionomer restorations. Class V preparations were made on the buccal and lingual/palatal surfaces of freshly extracted teeth. The cavities on each tooth were restored with Fuji II LC (FT [GC]) and Photac-Fil Quick (PF [3M-ESPE]) according to manufacturers' instructions. Immediately after light-polymerization, gross finishing was done with eight-fluted tungsten carbide burs. The teeth were then randomly divided into four groups and finishing/polishing was done with one of the following systems: (a) Robot Carbides (RC); (b) Super-Snap system (SS); (c) OneGloss (OG) and (d) CompoSite Polishers (CS). The sample size for each material-finishing/polishing system combination was eight. After finishing/polishing, the teeth were stored in distilled water at 37 degrees C for one week. The root apices were then sealed with acrylic and two coats of varnish was applied 1 mm beyond the restoration margins. The teeth were subsequently subjected to dye penetration testing (0.5% basic fuchsin), sectioned and scored. Data was analyzed using Kruskal-Wallis and Mann-Whitney U tests at a significance level of 0.05. Results of statistical analysis were as follows: Enamel margins: PF-OG<SS; FT-OG<RC; Dentin margins: PF-no significant difference; FT-OG & CS<RC. Regardless of the finishing/polishing technique, leakage at dentin margins was significantly greater than at enamel margins for FT. For PF, no significant difference in leakage scores was observed between dentin and enamel with the exception of finishing/polishing with OG. FT restorations had significantly less enamel and dentin leakage than PF restorations when treated with OG. The effect of finishing/polishing techniques on microleakage was both tissue and material dependent.

Acrylic Resins↗

Proteins of muscle subcellular fractions in Duchenne progressive muscular dystrophy stained with "stains-all" cationic carbocyanine dye and with Coomassie Blue.

The protein compositions of subcellular fractions of muscle obtained from 17 Duchenne dystrophy patients, 15 disease controls (10 different primary myopathies, 5 spinal muscular atrophy patients), and 10 normals were examined by polyacrylamide gel electrophoresis. The gels were stained with Coomassie Brilliant Blue and with "Stains-all," which stains calcium-binding proteins, sialic acid-rich glycoproteins, and phosphoproteins. In muscle membrane fractions of Duchenne dystrophy patients there was a marked reduction in the concentrations of calsequestrin and a 39 kDa protein that stained blue with "Stains-all." There were changes in the proteins of all subcellular fractions of Duchenne's patients; some of these changes appear to be specific for Duchenne dystrophy (DD). There was no apparent correlation between the protein changes observed on acrylamide gels and the age of the patients, the duration of the disease, the degree of disability, or activity of creatine kinase. A decreased level of calsequestrin in DD sarcoplasmic reticulum may contribute to an increased level of free calcium seen in muscle from these patients.

Calcium-Binding Proteins↗

Removal of a cationic dye from aqueous solutions by adsorption onto bentonite clay.

The ability of bentonite to remove malachite green from aqueous solutions has been studied for different adsorbate concentrations by varying the amount of adsorbent, temperature, pH and shaking time. Maximum adsorption of the dye, i.e. >90% has been achieved in aqueous solutions using 0.05 g of bentonite at a pH of 9. Thermodynamic parameters such as DeltaH degrees, DeltaS degrees and DeltaG degrees were calculated from the slope and intercept of the linear plots of lnK(D) against 1/T. Analysis of adsorption results obtained at 298, 308, 318 and 328 K showed that the adsorption pattern on bentonite seems to follow the Langmuir, Freundlih and D-R isotherms. The temperature increase reduces adsorption capacity by bentonite, due to the enhancement of the desorption step in the mechanism. The numerical values of sorption free energy (E(a)) of 1.00-1.12 kJ mol(-1) indicated physical adsorption. The kinetic data indicated an intraparticle diffusion process with sorption being first order. The rate constant k was 0.526 min(-1). The concentration of malachite green oxalate was measured before and after adsorption by using UV-Vis spectrophotometer.

Adsorption↗

Screening and confirmation of triphenylmethane dyes and their leuco metabolites in trout muscle using HPLC-vis and ESP-LC-MS.

An extraction and clean-up protocol for the determination of Malachite Green and Crystal Violet and the corresponding leuco compounds in trout muscle has been developed. Final determination is by HPLC with visible (screening) or ESP-MS (confirmation) detection. In both cases lead(IV) oxide was used on-line to oxidise the leuco compounds back to the parent after chromatographic separation and prior to detection. The procedure was validated down to 2 micrograms kg-1. Intra- and inter-batch precision was measured at 3 levels for all compounds. Recoveries were in the range 66-116% with RSD of 1-17% for determination by HPLC with visible detection. For LC-MS determination, recoveries were in the range 61-94% with RSD of 4-15%. Limited surveillance data indicated that Malachite Green usage was more effectively monitored by including the leuco compound as well as the parent (9 positives for the leuco compound as opposed to 1 for Malachite Green out of 31 samples analysed).

Aniline Compounds↗

Designing multidrug-resistance modulators circumventing the reverse pH gradient in tumours.

Multidrug-resistant tumours often exhibit a reverse pH gradient (acid outside), as they have an acid extracellular pH (pHe) and a neutral alkaline intracellular pH (pHi). This study was designed to test the hypothesis that the ability of lipophilic drugs to mediate multidrug resistance (MDR) reversal by interacting with the membrane phospholipids may be correlated with pH in resistant tumours. The permeation properties of five MDR modulators were therefore studied at 37 degrees C by quantifying their ability to induce the leakage of Sulfan blue through unilamellar anionic liposomes, over the range pH 6.5-7.7, and in the absence of any membrane potential (pHe = pHi). The dye leakage induced by two calcium blockers (diltiazem and verapamil) and two antiparasitic agents (thioacridine derivative and mepacrine) was found to significantly increase with the pH of the medium (P < 0.001), whereas that induced by a non-ionic detergent (Triton X-100) showed almost no pH-dependent variations. This process was a cooperative one (0.8 < Hill coefficient < 8.5) and the permeation doses inducing 50% dye leakage (PD50) ranged from 1.6 to 36.0 mM. The permeation ability of the MDR modulators (log(1/PD50)) significantly increased with their octanol-buffer distributions (logD) (slope = 0.35+/-0.06; y intercept = 1.65 +/- 0.14; P < 0.0001) and significantly decreased with their net electric charge (z) (slope = -0.48+/-0.07; y intercept = 2.85+/-0.08; P < 0.0001). A highly significant multiple correlation was found to exist between the variations of log(1/PD50) with those of logD and z (dlog(1/PD50)/dlogD = 0.21 +/- 0.05; dlog(1/PD50)/dz = -0.34+/-0.07; y intercept = 2.27+/-0.17; P < 0.000001). The results provide evidence that in resistant tumours (acid pHe and neutral alkaline pHi), the MDR reversal might be enhanced by favourable drug-membrane interactions if the modulators are designed in the form of highly lipophilic (logP approximately equals 4) mono-basic drugs with a near neutral pKa (pKa approximately equals 7-8).

Antineoplastic Agents↗

Laparoscopic assessment of the sentinel lymph node in early stage cervical cancer.

OBJECTIVE: The aim of this study was to describe a minimally invasive technique enabling us to identify the sentinel lymph node in patients affected by early stage cervical cancer and to report the preliminary data. METHOD: Patent Blue Violet was injected around the tumor. Laparoscopy was undertaken and the blue-dyed lymph nodes (BDLN) were sought. The evidenced BDLN were removed, and then the systematic dissection was carried out. Material. Thirty-five patients were submitted to surgery. A systematic dissection was performed on 69 pelvic sidewalls (no dissection was performed on the second side of the patient for whom we decided to renounce surgery after assessment of the first side). RESULTS: One or more BDLN was evidenced in 59 of 69 dissections. The rate of failure depends on the quantity of injected blue dye. Failure to identify a BDLN depended on the quantity of injected blue dye: 3 of 6 (50%) for 1.5 ml or less, 3 of 18 (17%) for 2 ml, and only 4 of 45 (10%) after injection of 4 ml (P = 0.05). Among the 63 BDLN (in 4 cases 2 BDLN were identified), 53 were located in contact with the external iliac vein, lateral to the inferior vesical artery, and ventral to the origin of the uterine artery, 7 were located close to the origin of one of the collaterals of the internal iliac artery, and 3 were adjacent to the left common iliac vein. One or more positive pelvic lymph nodes was found in 11 pelvic wall dissections done on 8 patients. The BDLN was the positive node or one of them in all cases. CONCLUSION: If the sensitivity of the assessment of the BDLN is confirmed to be 100%, this laparoscopic approach could transform the management of early cervical cancer.

Adenocarcinoma↗

Lymphatic mapping for melanomas of the upper extremity.

Over a period of 4 years, 127 consecutive patients with upper extremity melanomas were identified from a prospectively accrued database. A protocol consisting of preoperative lymphoscintigraphy and intraoperative lymphatic mapping and with a vital blue dye and radiocolloid was used; the protocol had a 98% success rate of identifying the sentinel lymph node (SLN). Preoperative lymphoscintigraphy identified unpredictable cutaneous lymphatic flow in 15 (12%) of the patients. These discordant areas would not have been included in classic regional node dissection and possible sites of metastatic disease would not have been identified. Metastatic disease was identified within the SLNs in 12 (9%) of the patients. Of the 12 patients with a positive SLN, 2 (17%) were found on complete node dissection to have metastatic disease in higher nodes in the regional basin. The SLN was the only site of disease in 10 of these 12 patients with documented metastases in the regional basin. Patients with a negative SLN biopsy can be spared the morbidity and expense of a complete lymph node dissection.

Arm↗