What are the NCCN guidelines on the use of sentinel lymph node biopsy (SLNB) for the treatment of breast cancer?

Updated: Sep 23, 2020
  • Author: Pavani Chalasani, MD, MPH; Chief Editor: John V Kiluk, MD, FACS  more...
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Answer

The NCCN guidelines recommend that SLNB should be performed and is the preferred method of axillary lymph node staging if the patient is an appropriate candidate for SLNB. [77] Candidates include patients who are clinically node negative at the time of breast cancer diagnosis, with or without 1–2 suspicious nodes on imaging, and for whom no preoperative systemic therapy is planned.

If the sentinel lymph node is negative, no further axillary surgery is a category 1 recommendation. The NCCN recommends axillary dissection level I/II if the sentinel node is not identified or if the sentinel node is positive but the patient fails to meet all the following criteria:

  • T1 or T2 tumor
  • Only one or two positive sentinel lymph nodes
  • Breast-conserving surgery
  • Whole-breast radiation therapy planned
  • No preoperative chemotherapy

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