ASCO Updates Guidelines on Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer (2024)

Rodrigo Arrangoiz MS, MD, FACS, FSSO

The American Society of Clinical Oncology (ASCO) has released updated guidelines on the use of sentinel lymph node biopsy (SLNB) in early breast cancer. The new recommendations are based on high-quality evidence and are designed to support de-escalation of axillary surgery where safe and appropriate. The six main points are:

Omission of SLNB is recommended in postmenopausal women (>50 years) with: Tumors <2 cm Clinically node-negative (cN0) HR-positive, HER2-negative Negative preoperative axillary ultrasound Undergoing breast-conserving surgery with planned whole-breast radiotherapy When SLNB is omitted, it should not influence decisions about radiotherapy or systemic adjuvant therapy. Treatment should still be guided by tumor biology and overall clinical risk. SLNB alone is sufficient in cT1–2N0 patients with 1–2 positive sentinel nodes undergoing breast-conserving surgery with whole-breast radiation. Completion ALND is not necessary. In patients with tumors <5 cm undergoing mastectomy, SLNB with 1–2 positive nodes may also be managed without ALND if postmastectomy radiotherapy is planned. ALND should not be performed in patients with negative SLNB. SLNB remains indicated in specific clinical scenarios: Men with operable breast cancer Pregnancy DCIS patients scheduled for mastectomy Multicentric invasive breast cancer Patients with prior breast or axillary surgery Obese patients Patients with cT3–T4, cN0 disease

Conclusion:

This update reinforces a personalized, evidence-based approach to axillary management in breast cancer. It highlights the importance of:

Ongoing medical education Multidisciplinary coordination Clear physician-patient communication The recommendations aim to reduce unnecessary morbidity from axillary surgery without compromising oncologic outcomes.

Reference:

Boughey JC, Dietz JR, Morrow M, et al. ASCO Guideline Update: Sentinel Lymph Node Biopsy for Patients With Early-Stage Breast Cancer. Journal of Clinical Oncology. 2024;42(12):1343-1355. DOI: 10.1200/JCO.24.00035

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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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