Sentinel node biopsy in breast cancer


Axillary lymph node dissection is not recommended for women with early stage breast cancer who do not have axillary nodal metastases.

Axillary lymph node dissection is not recommended for early stage breast cancer with 1-2 sentinel nodes positive for metastases and who received breast conserving surgery and conventional whole breast radiation.

Patients may be given axillary lymph node dissection with early stage breast cancer with nodal metastases found on sentinel node biopsy who will receive mastectomy.

Sentinel lymph node biopsy is not recommended for pregnant patients, clinically node positive disease, inflammatory breast cancer, mastectomy patients, male patients, or patients who receive neoadjuvant systemic therapy as complete actually lymph node dissection is the standard of care for these patients.

SNL is feasible, safe, and reliable for the prediction of residual nodal burden after a neoadjuvant systemic therapy.

Sentinel lymph nodes are more likely to contain metastatic breast carcinoma than non-SLNs.

Many women previously classified node negative are now classified minimally node positive.

It is now recognize the continuum of nodal tumor burden rather than a simplistic dichotomous stratification.

The more sections evaluated from SLNs the more metastases are identified.

Slicing the SLN no thicker than 2.0 mm and correct embedding of the slices assureS the identification of all macrometastases larger than 2.0 mm, but smaller metastases will be missed.

The majority of patients diagnosed with breast cancer today derive little benefit from axillary clearance.

Trends are present now to omit sentinel node biopsy in patients with T1 lesions, and in older women as it  is recommended by the Choosing Wisely guidance of the Society of Surgical Oncology, and by the SOUND trial study.

The omission of axillary surgery was non-inferior in SLNB in patients with small breast cancers and negative results on ultrasound of the axillary lymph nodes: patients with these features can be spared axillary surgery whenever the lack of pathological information does not affect the postoperative treatment plan (SOUND Trial Group).

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