SLN biopsy for large and/or multicentric breast cancers: should we worry?

摘要

Sentinel lymph node (SLN) biopsy for breast cancer is one of the great success stories in contemporary surgical oncology and over the last 15 years has become standard care for axillary lymph node staging at many institutions worldwide. This striking trend is supported by a substantive literature of well over 3000 publications; these include 69 observational studies of SLN biopsy validated by a planned backup axillary dissection (ALND),1 in which SLN were identified in 96% of cases and were falsely negative in 7% of node-positive patients, results which have been confirmed in 5 randomized trials. It is now quite clear that axillary local recurrence as a consequence of false-negative SLN biopsy is a rare event, occurring in about 0.3% of SLN-negative patients.7 The early caution in selection of patients for SLN biopsy (which in many centers was limited to those with Tl cancers) is no longer justified, and SLN biopsy now appears suitable for virtually all patients with operable clinically node-negative (cTl-3N0) invasive breast cancers.