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Arch Surg. 2000;135:605.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

I have read with interest the article by Orr et al¹ and agree entirely with their recommendation that surgeons beginning to do sentinel lymph node (SLN) biopsy should perform backup axillary lymph node dissection (ALND) early in their experience. I find their other considerations anything but practical.

Any model is only as good as its assumptions.

• Their assumption of a 38% failure rate (based on the earliest experiences of Giuliano et al² and Guenther et al³ when the technique of SLN biopsy was still evolving) ignores more than 30 subsequent studies in which the failure rate of the authors' early experience averaged 10% or less.
  
• This same literature reports an overall false-negative rate of about 5%, not 26%, as they assume in their model.
  
• They raise the specter of a 3% axillary recurrence rate after negative SLN biopsy without mentioning that this figure is derived from experience with melanoma,⁴ not . . . [Full Text of this Article]