Arguments against the sentinel lymph node biopsy for a select group of invasive breast cancer patients suitable for breast-conserving surgery and adjuvant systemic therapy

摘要

Sentinel lymph node biopsy (SLNB) is the standard technique for assessment of the nodal status followed by axillary lymph node dissection (ALND) for SLNB-positive patients. SLNB used to serve two purposes; diagnostic to stage the axilla and for decisions to use adjuvant systemic therapy. Nodal status is still the most important prognostic factor. It also serves as a therapeutic procedure in 60% of cases where SLN is the only involved node as no further metastasis is present in the non- SLNs after ALND (1).Management of the metastatic sentinel lymph nodes is changing very rapidly after the publication of Z0011 trial which showed that further axillary surgery is not required in a select group of patients with lower residual axillary disease treated with adjuvant systemic therapy and tangential-field whole-breast radiotherapy without compromising the surgical outcomes (2).