Sentinel lymph node biopsy as an alternative to routine axillary lymph node dissection in breast cancer patients

Abstract

Sentinel lymph node (SLN) biopsy is a useful way of assessing axillary nodal status and obviating axillary lymph node dissection (ALND) in patients with node-negative breast cancer. Because SLN technology is evolving rapidly, however, variation in technique is widespread, and no standardization has yet been accomplished. This review discusses the feasibility and accuracy of this procedure and suggests the optimal method for identifying the SLN and detecting micrometastases. Although the SLN can be successfully identified by either the dye-guided or gamma probe-guided method in experienced hands, identification is facilitated when the two techniques are used together. In the gamma probe-guided method, the use of a large-sized radiotracer (particle size, 200-1000 nm) may be preferred because only one or two SLNs are identified. To increase the chance of finding metastases in SLN, it is desirable to make step sections with hematoxylin and eosin staining on permanent and frozen sections. The addition of immunohistochemistry may improve the accuracy of SLN diagnosis. The intraoperative examination of imprint cytology may be useful in determining the status of the SLNs, but further studies are needed to establish whether it has additional value when combined with the frozen section. In practice, routine ALND can be avoided when there is documentation of extensive experience and a low false-negative rate with the technique in the hands of a particular surgeon and hospital team. Particularly, SLN biopsy is more successful and has a lower false-negative rate in patients with smaller tumors. However, investigation of long-term regional control and survival in a prospective randomized trial is necessary, before SLN biopsy can replace routine ALND as the preferred staging operation for women with breast cancer.

Sentinel lymph node biopsy for breast cancer patients using fluorescence navigation with indocyanine green

“…Veronesi et al suggested the possibility that a total dissection of the axillary lymph nodes is not always necessary, and a large scale RCT was carried out [1,2,20-29]. These reported successful lymphatic mapping in 92% using a combination of a dye and a gamma probe method.…”

“…However, some reports have suggested that there might be an association between micrometastasies in the lymph nodes and distant metastasis [27-29]. The prognostic significance of a micrometastasis in terms of metastatic risk is controversial [1,2,20-29]. …”

“…The major problem of axillary dissection is that it produces various morbidities such as serome, infection, numbness and lymphadema of the arm [1,2]. Since April 2010, this technique has been covered by the national health insurance in Japan, promoting its wide use in clinical settings.…”

Sentinel Lymph Node Biopsy in Breast Cancer

“…22, 23 Additionally, markers have been subjectively placed in different regions of the breast with subareolar, peritumoral and intratumoral being described. 22, 24 However, it is still unclear in which technique is superior with no existing large sample head to head study. 25 In general it appears that SLNB is successful independent of the site of injection.…”

Sentinel lymph node biopsy as an alternative to routine axillary lymph node dissection in breast cancer patients

“…A recent article by Noguchi [1] regarding sentinel node biopsy as an alternative to routine axillary node dissection in breast cancer patients is most timely and appropriate. Noguchi [1] wrote a comprehensive overall literature review and presented new Japanese data of the current status of sentinel lymph node biopsy. I would agree with his central thesis as expressed in the title of his article; at present, sentinel node biopsy is an acceptable alternative to routine axillary dissection in breast cancer.…”