How do we evaluate sentinel nodes and interpret the findings?
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Sentinel lymph node (SLN) biopsy has become standard care for axillary lymph node staging, allowing routine, pathologic SLN examination by serial sections (SS) and/or immunohistochemical (IHC) stains. Although these methods increase the accuracy of staging, the prognostic significance of SLN micrometastases (pN0i+ [< 0.2 mm] and pN1mi [0.2–2 mm]), and especially of those detected only by IHC, is controversial. Retrospective studies have addressed this issue by relating survival to size of nodal metastasis, or by using SS and/or IHC to reassess nodes initially staged as negative, and suggest but do not conclusively prove that SLN micrometastases are associated with a modest decrement in overall and/or disease-free survival. Because there is no current standardized protocol for the pathologic assessment of SLN, prospective trials in progress will establish whether SS and/or IHC are worthwhile.
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