“Role of Sentinel Lymph Node Biopsy in Clinically Node-Negative Breast Cancer: A Prospective Study”

Abstract

Sentinel lymph node biopsy (SLNB) has transformed axillary staging in early breast cancer by providing accurate nodal assessment while substantially reducing morbidity compared with complete axillary lymph node dissection (ALND)). The purpose of the study is to determine the accuracy of diagnostics used, false-negative rate, morbidity, and oncologic outcome of SLNB in patients with clinically node-negative (cN0) breast cancer and whose treatment is three years in a tertiary cancer centre. The second outcomes (sentinel node identification rate, false-negative rate, arm morbidity (lymphedema, shoulder dysfunction), local/regional recurrence, disease free and overall survival at minimum median follow-up, (36 months) were the important ones. We have established that our identification rates (>95%), in well established dual-tracer tests, of adequate node recovery are high, and that there are overall large changes in morbidity rates in both the short term and long-term as compared with the historic ALND cohorts. In combination with modern adjuvant systemic therapy and individualized radiotherapy, omissions of an incremental ALND in which complete replaces the excision of small limited-size sentinel node metastases does not appear to have a negative impact on oncologic outcome. The article endorses a guideline-based practice that underpins SLNB on how to handle the treatment of staging cN0 early breast cancer yet cites technical and pathological considerations, which can be used to interfere with the accuracy and the need to exercise caution and long-term follow-ups on patients. Contemporary technical arguments of the trial and guideline modifications useful to the contemporary practice are discussed.