The Value of Sentinel Lymph Node Biopsy in Determining Optimal Therapy for Breast Cancer

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Axillary lymph node dissection (ALND) is typically a standard part of the care of patients with breast cancer. It offers the most precise information about prognosis, controls potential metastatic disease in the axilla, and may provide a small survival advantage. Unfortunately, the procedure is expensive, uncomfortable, and associated with potential long term morbidity. Sentinel node biopsy (SNB) has been proposed as a minimally invasive method for axillary staging, with avoidance of full ALND in those cases (the majority) where the sentinel node is histologically negative. When done by experienced surgeons, the sentinel node is identified in at least 95% of cases, with a minimal (<5%) false negative rate. Immunohistochemistry may be performed selectively on the sentinel node, and upstages up to 20% of putative node negative patients. Nevertheless, SNB has a significant learning curve, with inexperienced surgeons identifying a sentinel node less frequently (in 60 to 80% of cases) with more false negatives. Use of SNB by inexperienced surgeons may lead to undertreatment (not using chemotherapy and/or hormonal therapy) and possible axillary recurrence. SNB is gradually replacing ALND as the standard of care for patients with the early stage of breast cancer, but the clinician must be aware of local surgeon and institution experience. Until each surgical team has documented their expertise with SNB, full ALND should be considered the local standard of care.

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