SENTINEL LYMPH NODE DISSECTION IN EARLY-STAGE BREAST CANCER
Standards, controversies and future considerations

Karen T. Lane, MD and Laura J. Esserman, MD, MBA

Sentinel lymph node dissection (SLND) was developed in an effort to find a less invasive way of evaluating axillary lymph nodes than through axillary lymph node dissection (ALND), which incurs considerable morbidity including lymphedema (10% to 20% in Level I and II ALND), damage to nerves and blood vessels, reduced arm mobility and postoperative pain.

 

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Top-line summary
Axillary lymph node sampling plays an important role in the evaluation and treatment of women with breast cancer. Involvement of these nodes often provides the pivotal information for making decisions about adjuvant therapy: as a significant predictor of the likelihood of developing future metastatic disease, it forecasts the absolute risk reduction afforded by either hormonal treatment or chemotherapy. Some clinicians also believe that excising the axillary nodes may improve locoregional control, although survival benefit has not been established. How the axilla are evaluated has undergone a number of changes over the last 10 years. Sentinel lymph node dissection (SLND), which identifies the lymphatic drainage pattern of the breast, aims to determine whether tumour cells have spread outside the breast via the lymphatic system to the lymph nodes. When the SLND is found to be negative for tumour it substitutes for a more aggressive surgical procedure, axillary lymph node dissection. Experienced surgeons who perform the procedure at least twice a week are able to identify the sentinel node in over 95% of patients. This article reviews current optimal procedures and discusses areas of ongoing debate and inquiry including injection techniques, pathologic assessment and use in various patient populations. It also describes the potential role of assessing hematogenous spread through analysis of the bone marrow.
 
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