Management of Patients with Tumor-Free Sentinel Lymph Nodes in Breast Cancer

• Randomized clinical trials support the use of SLNB without ALND:
  • For node-negative patients
• These studies demonstrated very low axillary recurrence rates:
  • In patients with negative sentinel lymph nodes:
    • Regardless of receptor status
    • Type of breast operation
    • Patient age
• The ASCO guidelines state:
  • That women with early-stage breast cancer without sentinel nodal metastases:
    • Should not undergo ALND
• The first use of SLNB without ALND was a prospective observational study in 1994:
  • Which evaluated 125 patients with SLNB alone
• NSABP B-32:
  • A phase III trial involving 80 centers in Canada and the United States
  • Prospectively randomized 3,989 sentinel lymph node–negative patients to SLNB plus ALND or SLNB alone
  • Patients were stratified based on age, tumor size, and surgical approach
  • Regional recurrence was rare in both patients who underwent SLNB alone and those who had a completion ALND and was not statistically significantly different
  • Of the 22 regional events in both groups:
    • 10 breast cancer recurrences were in the axilla:
      • For a rate of less than 1%
    • Two of these recurrences occurred in patients who were treated with ALND and eight in patients who underwent SLNB alone
    • There was no difference in overall or disease-free survival between groups:
      • And there were fewer complications in the SLNB-alone group
  • The results of NSABP B-32:
    • Have also been seen in other studies
• Guided by this strong evidence:
  • SLNB alone has replaced ALND for sentinel node–negative patients

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