PURPOSE: We previously demonstrated increased detection of axillary metastases using sentinel lymphadenectomy (SLND) and immunohistochemistry. These methods have evolved and we now report our current use of these techniques and our most recent results of axillary staging with SLND. PATIENTS AND METHODS: One hundred seven consecutive women (previously unreported) with breast cancer underwent SLND followed by completion axillary lymphadenectomy (ALND). All sentinel nodes were examined intraoperatively with frozen section and postoperatively with hematoxylin and eosin staining (H&E) plus immunohistochemical staining (IHC) using antibody to cytokeratin. The nonsentinel axillary nodes were examined with H&E, but not IHC. RESULTS: The median age was 56.6 years (range, 28 to 90). Most patients (58.9%) were postmenopausal, most primary tumors (62.6%) were palpable, and most operations (86.9%) were breast-conserving. The mean tumor size was 2.11 +/- 1.38 cm. Sentinel nodes were identified in 100 patients: 42 patients had metastases in sentinel nodes; of these, 28 (66.7%) had no other involved axillary nodes. On average, 1.8 +/- 1.1 sentinel nodes were examined and 20.3 +/- 7.8 nonsentinel nodes were removed. Of seven patients with no identified sentinel nodes, six had a tumor-negative axilla. SLND was 100% predictive of axillary status in these 100 women. CONCLUSION: In this population of breast cancer patients, SLND with frozen section and IHC was a minimally invasive, highly accurate intraoperative method of axillary staging. We are evaluating the elimination of routine ALND for sentinel-node negative women to minimize the morbidity associated with standard dissections. The ability to identify node-negative patients without ALND would be a welcome addition to the management of women with breast cancer.