What is the role of sentinel lymph node (SLN) biopsy in the surgical treatment of breast cancer?

Updated: Feb 13, 2019
  • Author: Mary Jo Wright, MD; Chief Editor: James Neal Long, MD, FACS  more...
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Sentinel lymph node (SLN) biopsy is a minimally invasive procedure designed to stage the axilla in breast cancer patients who have clinically negative nodes. Sentinel nodes are the first node or first group of nodes that drain from the breast to the axilla.

SLN biopsy has become the preferred SLN technique for axillary staging, because it offers accuracy equivalent to that of axillary lymph node dissection with less morbidity. [19] According to the American College of Breast Surgeons (ACBS), SLN biopsy is suitable for virtually all clinically node-negative T1-2 invasive breast cancers. Limited data are available regarding the suitability of SLN biopsy for patients with the following conditions [19] :

  • T3 cancers

  • Multifocal/multicentric disease

  • Prior radiation therapy

  • Prior breast/axillary surgery

SLN biopsy appears to be feasible in patients who have had minimal axillary surgery, especially previous SLN surgery and radiotherapy. The ACBS advises that the decision to use SLN biopsy in these situations requires individualized surgical judgment and an unequivocally successful mapping procedure.

SLN biopsy is also indicated in patients with ductal carcinoma in situ (DCIS) in whom mastectomy is required or in whom invasive disease is suspected. The role of SLN biopsy in patients who have had neoadjuvant therapy remains controversial and is currently under study.

There is no role for SLN biopsy in inflammatory breast cancer. [19]

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