Sentinel Lymph Node Biopsy in Early Breast Cancer: Has Its Time Come?

Extract

The rationale behind the use of sentinel node biopsy in the management of early-stage breast cancer is straightforward—namely, to obtain the information on stage and prognosis needed to guide further treatment in a manner that avoids morbidity associated with full axillary dissection in patients whose sentinel lymph nodes are negative. Because sentinel lymph node biopsy is applicable to many newly diagnosed breast cancer patients, the consequences of its adoption are potentially substantial, and data from clinical trials that compare it with more standard approaches are critical. To be fully informative, such trials must demonstrate that sentinel lymph node biopsy achieves its goal of reducing patient morbidity but does not result in poorer disease control. In this issue of the Journal, Mansel et al. ( 1 ) illustrate that accomplishing these dual goals presents two key challenges: 1) assessing patient morbidity in a reliable and convincing fashion and 2) deciding what to do when the short-term morbidity results show benefit but the longer-term disease outcomes are not known.