Sentinel Lymph Node Surgery for Contralateral Prophylactic Mastectomy (CPM) – American Society of Breast Surgeons (ASBrS) Evidence-Based Recommendations

  • The benefit of performing sentinel lymph node (SLN) surgery at the time of CPM is:
    • That the lymph nodes have been evaluated in the event that an occult malignancy is found
  • The downside is:
    • Increased surgical morbidity such as lymphedema
  • By meta-analysis:
    • The risk of lymphedema after SLN alone is:
      • 5.6 % (95 % CI 6.1–7.9 %) and increases with longer follow-up
    • The chance of finding occult invasive disease in a prophylactic mastectomy is:
      • 1.8 %
    • An additional small percent of CPM specimens harbor noninvasive disease:
      • That would not require nodal evaluation
    • The rate of nodal positivity in patients with occult malignancy in CPM is:
      • Only 1.3 %
    • Considering these data:
      • Routine SLN surgery at time of CPM:
        • Places more patients at risk of lymphedema:
          • Than would be expected from the 1% to 2 % of patients with occult disease undergoing axillary dissection
        • Therefore the consensus group:
          • Does not recommend routine SLN for CPM
  • Patients at higher risk of contralateral occult malignancy are:
    • Postmenopausal patients
    • Those with triple-negative
    • Locally advanced
    • Inflammatory breast cancer
    • Invasive lobular disease
  • MRI at the time of breast cancer diagnosis:
    • Identifies occult contralateral disease:
      • 2% to 4 % of the time
    • Suspicious lesions in the contralateral breast should be biopsied:
      • But if a biopsy is not done:
        • SLN surgery should be considered for highly suspicious lesions
  • Summary:
    • Sentinel lymph node surgery on the CPM side should not be routinely performed
  • References:
    • Contralateral Prophylactic Mastectomy Consensus Statement from the American Society of Breast Surgeons: Additional Considerations and a Framework for Shared Decision Making. Ann Surg Oncol (2016) 23:3106–3111

#Arrangoiz #BreastSurgeon #CancerSurgeon #Teacher #SurgicalOncology #CASO #Miami #CenterforAdvancedSurgicalOncology #BreastCancer #ProphylacticMastectomy #CPM #ContralateralProphylacticMastectomy

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