Sentinel Lymph Node Biopsy in the Setting of a Risk Reducing Mastectomy

  • Prophylactic Mastectomy / Risk Reducing Mastectomy:
    • Rates are rapidly rising in the United States
  • Prophylactic mastectomy:
    • May be associated with a 3.5% to 5% occurrence of occult carcinoma:
      • Depending on the indication for the operation
  • SLNB at the time of prophylactic mastectomy:
    • May eliminate the need for ALND if occult disease is identified
  • A recent meta-analysis reviewed 14 studies where SLNB was routinely performed for prophylactic mastectomy in patients undergoing bilateral mastectomy for unilateral cancer:
    • This study found metastatic disease in the SLNB of the prophylactic mastectomy:
      • In 0 to 4% of patients with contralateral cancer
    • The majority of metastatic disease was associated with:
      • Contralateral axillary tumor spread from the primary tumor:
        • Not an occult primary tumor
    • In patients who were found to have occult malignancy in the prophylactic mastectomy breast:
      • Less than 1% of sentinel lymph nodes were positive for metastatic disease
  • Given the low rates of occult malignancy and axillary metastasis:
    • SLNB is not indicated for patients undergoing prophylactic mastectomy

#Arrangoiz #BreastSurgeon #BreastExpert #BreastCancer #CancerSurgeon #SurgicalOncologist #MountSinaiMedicalCenter #MSMC #Miami #Mexico #SLNM #SLNB #SentinelLymphNodeBiospy

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