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

#Arrangoiz #CancerSurgeon #BreastSurgeon #SurgicalOncologist #BreastExpert #BreastCancer #SLNM #SLNB #SentinelLymphNodeBiopsy #Surgeon #Teacher #MSMC #MountSinaiMedicalCenter #Miami #Mexico

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