Role of sentinel node biopsy in breast cancer: a review

Abstract

Axillary lymph node involvement is still an important predictor of recurrence and survival in breast cancer. Axillary staging was classically done by axillary lymph node dissection (ALND), but the introduction of sentinel lymph node biopsy (SLNB) has led to a progressive and continuing de-escalation in its use. Therefore, SLNB can now be considered the standard procedure for axillary staging in clinically N0 patients. Different studies have also begun to report that a positive sentinel node does not always require ALND, reducing the morbidity derived from this technique. Fears that this sentinel node approach might not be accurate for neoadjuvant chemotherapy have been allayed by several studies showing that post-neoadjuvant SLNB in clinical N0 patients reduces the rate of ALND. This approach benefits from axillary pathological complete response with an acceptable false-negative rate. By contrast, however, cN1 disease still requires that we optimise the technique to reduce the rate of false negatives. Currently, SLNB is the best method for axillary staging in breast cancer, allowing patients to be treated according to risk of recurrence, and with good evidence that morbidity is lower than with other more radical techniques.