From the Department of Medicine, Duke University, and the Duke Comprehensive Cancer Center, Durham, NC; Memorial Sloan Kettering Cancer Center, NY, NY; and Roswell Park Cancer Institute, Buffalo, NY
Authors’ disclosures of potential conflicts of interest are found at the end of this article.
Address reprint requests to Gary H. Lyman, MD, MPH, Medical Oncology, Department of Medicine, Duke University, and the Duke Comprehensive Cancer Center, 2424 Erwin Road, Suite 205, Durham, NC 27705; e-mail: gary.lyman{at}duke.edu
Overview: Lymphatic mapping and sentinel node biopsy have been shown to accurately stage the axilla in patients with early-stage breast cancer. Multiple cohort studies and recent randomized controlled trials suggest that sentinel node biopsy can be reliably performed in many patients with early-stage breast cancer, thereby reducing the morbidity associated with full axillary dissection. Sentinel node biopsy is now widely used in most major institutions caring for patients with breast cancer. The American Society of Clinical Oncology (ASCO) Clinical Practice Guidelines support the use of sentinel node biopsy in selected patients with early-stage breast cancer and its use as an alternative to full axillary dissection when the sentinel nodes are histologically negative. Although recent studies have further defined the role for this approach in patients with newly diagnosed breast cancer, a number of important clinical questions remain. This education session will review the major recommendations of ASCO Guidelines along with the supporting evidence, as well as recent and emerging data on the evaluation of patients with a positive sentinel node, the role of sentinel node biopsy following neoadjuvant systemic therapy, and the management of ductal carcinoma in situ. Sentinel node biopsy is a valuable tool to be used along with good clinical judgment in properly equipped centers to provide patients with early-stage breast cancer optimal outcomes for their disease.
