Skip to main content

Advertisement

SpringerLink
Log in

Sentinel Lymph Node Biopsy in Primary Breast Cancer: Window to Management of the Axilla

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

In patients with primary breast cancer, several large, randomized prospective trials have shown that sentinel node biopsy (SNB) substantially reduces the morbidity associated with axillary surgery compared with formal axillary lymph node dissection (ALND). Moreover, the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-32 trial has demonstrated that when the sentinel node reveals no evidence of metastatic disease, then no further ALND is required. Recently, the results of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial have challenged the notion that all patients with metastases to the sentinel node require ALND. The results of this trial suggest that in selected sentinel node-positive patients, ALND can be potentially avoided. Yet, some concerns about the ACOSOG Z0011 trial have been raised, and these concerns may have implications in the widespread implementation of the results of this trial. Since the advent of the SNB technology, occult metastases within the sentinel node are frequently observed, and the significance of these findings remains controversial. Finally, this review considers special situations, such as pregnancy and the neoadjuvant setting, where the use of SNB should be applied judiciously. The SNB technology has dramatically improved the quality of life for women with breast cancer, and further modifications of its role in breast cancer treatment should be based on evidence obtained from randomized, controlled trials.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Halsted WS (1907) I. The results of radical operations for the cure of carcinoma of the breast. Ann Surg 46(1):1–19

    Article  PubMed  CAS  Google Scholar 

  2. Fisher B, Montague E, Redmond C et al (1977) Comparison of radical mastectomy with alternative treatments for primary breast cancer. A first report of results from a prospective randomized clinical trial. Cancer 39(6 Suppl):2827–2839

    Article  PubMed  CAS  Google Scholar 

  3. Devitt JE (1965) The significance of regional lymph node metastases in breast carcinoma. Can Med Assoc J 93:289–293

    PubMed  CAS  Google Scholar 

  4. Cancer Research Campaign Working Party (1980) Cancer research campaign (King’s/Cambridge) trial for early breast cancer. A detailed update at the tenth year. Lancet 2(8185):55–60

    Google Scholar 

  5. Veronesi U, Paganelli G, Viale G et al (2003) A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med 349(6):546–553

    Article  PubMed  Google Scholar 

  6. David NK, Stewart JA, Thomas BJ et al (2007) Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial. Lancet Oncol 8(10):881–888

    Article  Google Scholar 

  7. Mansel RE, Fallowfield L, Kissin M et al (2006) Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: The ALMANAC Trial. JNCI J Natl Cancer Inst 98(9):599–609

    Article  Google Scholar 

  8. Zavagno G, De Salvo GL, Scalco G et al (2008) A randomized clinical trial on sentinel lymph node biopsy versus axillary lymph node dissection in breast cancer. Ann Surg 247(2):207–213

    Article  PubMed  Google Scholar 

  9. Del Bianco P, Zavagno G, Burelli P et al (2008) Morbidity comparison of sentinel lymph node biopsy versus conventional axillary lymph node dissection for breast cancer patients: results of the sentinella-GIVOM Italian randomised clinical trial. Eur J Surg Oncol 34(5):508–513

    Article  PubMed  Google Scholar 

  10. Purushotham AD (2005) Morbidity after sentinel lymph node biopsy in primary breast cancer: results from a randomized controlled trial. J Clin Oncol 23(19):4312–4321

    Article  PubMed  Google Scholar 

  11. Gill G (2008) Sentinel-lymph-node-based management or routine axillary clearance? one-year outcomes of sentinel node biopsy versus axillary clearance (SNAC): a randomized controlled surgical trial. Ann Surg Oncol 16(2):266–275

    Article  PubMed  Google Scholar 

  12. McLaughlin SA, Wright MJ, Morris KT et al (2008) Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: objective measurements. J Clin Oncol 26(32):5213–5219

    Article  PubMed  Google Scholar 

  13. Kett K, Varga G, Lukacs L (1970) Direct lymphography of the breast. Lymphology 3(1):2–12

    PubMed  CAS  Google Scholar 

  14. Krag DN, Weaver DL, Alex JC, Fairbank JT (1993) Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe. Surg Oncol 2(6):335–339 discussion 340

    Article  PubMed  CAS  Google Scholar 

  15. Giuliano AE, Kirgan DM, Guenther JM, Morton DL (1994) Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg 220(3):391–398 discussion 398-401

    Article  PubMed  CAS  Google Scholar 

  16. Albertini JJ, Lyman GH, Cox C et al (1996) Lymphatic mapping and sentinel node biopsy in the patient with breast cancer. JAMA 276(22):1818–1822

    Article  PubMed  CAS  Google Scholar 

  17. Cox CE, Haddad F, Bass S et al (1998) Lymphatic mapping in the treatment of breast cancer. Oncology (Williston Park) 12(9):1283–1292 discussion 1293-1284, 1297-1288

    CAS  Google Scholar 

  18. Morrow M, Rademaker AW, Bethke KP et al (1999) Learning sentinel node biopsy: results of a prospective randomized trial of two techniques. Surgery 126(4):714–720 discussion 720-722

    Article  PubMed  CAS  Google Scholar 

  19. Ashikaga T, Krag DN, Land SR et al (2010) Morbidity results from the NSABP B-32 trial comparing sentinel lymph node dissection versus axillary dissection. J Surg Oncol 102(2):111–118

    Article  PubMed  Google Scholar 

  20. Kell MR, Burke JP, Barry M, Morrow M (2010) Outcome of axillary staging in early breast cancer: a meta-analysis. Breast Cancer Res Treat 120(2):441–447

    Article  PubMed  Google Scholar 

  21. Singletary SE, Allred C, Ashley P et al (2002) Revision of the American Joint Committee on Cancer staging system for breast cancer. J Clin Oncol 20(17):3628–3636

    Article  PubMed  Google Scholar 

  22. Weaver DL, Ashikaga T, Krag DN et al (2011) Effect of occult metastases on survival in node-negative breast cancer. N Engl J Med 364(5):412–421

    Article  PubMed  CAS  Google Scholar 

  23. Giuliano AE, Hawes D, Ballman KV et al (2011) Association of occult metastases in sentinel lymph nodes and bone marrow with survival among women with early-stage invasive breast cancer. JAMA 306(4):385–393

    Article  PubMed  CAS  Google Scholar 

  24. Duncan PG, Pope WD, Cohen MM, Greer N (1986) Fetal risk of anesthesia and surgery during pregnancy. Anesthesiology 64(6):790–794

    Article  PubMed  CAS  Google Scholar 

  25. Gentilini O, Masullo M, Rotmensz N et al (2005) Breast cancer diagnosed during pregnancy and lactation: biological features and treatment options. Eur J Surg Oncol 31(3):232–236

    Article  PubMed  CAS  Google Scholar 

  26. Stearns V, Ewing CA, Slack R, Penannen MF, Hayes DF, Tsangaris TN (2002) Sentinel lymphadenectomy after neoadjuvant chemotherapy for breast cancer may reliably represent the axilla except for inflammatory breast cancer. Ann Surg Oncol 9(3):235–242

    Article  PubMed  Google Scholar 

  27. Hidar S, Bibi M, Gharbi O et al (2009) Sentinel lymph node biopsy after neoadjuvant chemotherapy in inflammatory breast cancer. Int J Surg 7(3):272–275

    Article  PubMed  Google Scholar 

  28. Hunt KK, Yi M, Mittendorf EA et al (2009) Sentinel lymph node surgery after neoadjuvant chemotherapy is accurate and reduces the need for axillary dissection in breast cancer patients. Ann Surg 250(4):558–566

    PubMed  Google Scholar 

  29. Mamounas EP, Brown A, Anderson S et al (2005) Sentinel node biopsy after neoadjuvant chemotherapy in breast cancer: results from National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol 23(12):2694–2702

    Article  PubMed  Google Scholar 

  30. Reynolds C, Mick R, Donohue JH et al (1999) Sentinel lymph node biopsy with metastasis: can axillary dissection be avoided in some patients with breast cancer? J Clin Oncol 17(6):1720–1726

    PubMed  CAS  Google Scholar 

  31. Krag DN (2004) NSABP-32: Phase III, randomized trial comparing axillary resection with sentinal lymph node dissection: a description of the trial. Ann Surg Oncol 11(3 Suppl):208S–210S

    PubMed  Google Scholar 

  32. Degnim AC, Griffith KA, Sabel MS et al (2003) Clinicopathologic features of metastasis in nonsentinel lymph nodes of breast carcinoma patients. Cancer 98(11):2307–2315

    Article  PubMed  Google Scholar 

  33. Van Zee KJ, Manasseh DM, Bevilacqua JL et al (2003) A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy. Ann Surg Oncol 10(10):1140–1151

    Article  PubMed  Google Scholar 

  34. Pal A, Provenzano E, Duffy SW, Pinder SE, Purushotham AD (2008) A model for predicting non-sentinel lymph node metastatic disease when the sentinel lymph node is positive. Br J Surg 95(3):302–309

    Article  PubMed  CAS  Google Scholar 

  35. Kohrt HE, Olshen RA, Bermas HR et al (2008) New models and online calculator for predicting non-sentinel lymph node status in sentinel lymph node positive breast cancer patients. BMC Cancer 8:66

    Article  PubMed  Google Scholar 

  36. Mittendorf EA, Hunt KK, Boughey JC et al (2012) Incorporation of sentinel lymph node metastasis size into a nomogram predicting nonsentinel lymph node involvement in breast cancer patients with a positive sentinel lymph node. Ann Surg 255(1):109–115

    Article  PubMed  Google Scholar 

  37. Jeruss JS, Newman LA, Ayers GD et al (2008) Factors predicting additional disease in the axilla in patients with positive sentinel lymph nodes after neoadjuvant chemotherapy. Cancer 112(12):2646–2654

    Article  PubMed  Google Scholar 

  38. Giuliano AE, Hunt KK, Ballman KV et al (2011) Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA 305(6):569–575

    Article  PubMed  CAS  Google Scholar 

  39. Caudle AS, Hunt KK, Kuerer HM et al (2011) Multidisciplinary considerations in the implementation of the findings from the American College of Surgeons Oncology Group (ACOSOG) Z0011 study: a practice-changing trial. Ann Surg Oncol 18(9):2407–2412

    Article  PubMed  Google Scholar 

  40. Jatoi I, Chen BE, Anderson WF, Rosenberg PS (2007) Breast cancer mortality trends in the United States according to estrogen receptor status and age at diagnosis. J Clin Oncol 25(13):1683–1690

    Article  PubMed  Google Scholar 

  41. Jatoi I (2011) Axillary vs sentinel lymph node dissection for invasive breast cancer. JAMA 305(22):2288 author reply 2290-2281

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA

    Ashwini Kumar, Ruchir Puri, Pranjali V. Gadgil & Ismail Jatoi

Authors
  1. Ashwini Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ruchir Puri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pranjali V. Gadgil
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ismail Jatoi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ismail Jatoi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kumar, A., Puri, R., Gadgil, P.V. et al. Sentinel Lymph Node Biopsy in Primary Breast Cancer: Window to Management of the Axilla. World J Surg 36, 1453–1459 (2012). https://doi.org/10.1007/s00268-012-1635-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-012-1635-8

Keywords

Search

Navigation