The proper management of the axilla in all patients with breast cancer has been an area of active investigation. Although involvement of the axillary nodes remains an important prognostic factor, the approach to gathering this information has changed dramatically. Axillary lymph node dissection (ALND), long a standard component of the management of early stage breast cancer, remains the standard approach only for patients with clinically palpable axillary nodes or many positive axillary nodes confirmed by sampling techniques. For women with early stage breast cancer with a clinically negative axilla, ALND is no longer a routine part of the surgical treatment of breast cancer, having been replaced with the less invasive sentinel lymph node biopsy (SLNB).
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2In patients with clinically node negative breast cancer, SLNB identifies patients without axillary node involvement, sparing them the morbidity of ALND.
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Several studies have shown that SLNB is associated with lower rates of arm morbidity, including lymphedema, sensory loss, and range of motion deficits when compared to a standard ALND.
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- American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer.J Clin Oncol. 2005; 23: 7703-7720
- Survival outcomes in node negative breast cancer patients evaluated with complete axillary node dissection versus sentinel lymph node biopsy.Ann Surg Oncol. 2006; 13: 708-711
- Sentinel node mapping for breast cancer: progress to date and prospects for the future.Surg Oncol Clin N Am. 2007; 16: 55-70
- Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the American College of Surgeons Oncology Group Trial Z0011.J Clin Oncol. 2007; 25: 3657-3663
- Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial.J Natl Cancer Inst. 2006; 98: 599-609
- Post-operative arm morbidity and quality of life. Results of the ALMANAC randomized trial comparing sentinel node biopsy with standard axillary treatment in the management of patients with early breast cancer.Breast Cancer Res Treat. 2006; 95: 279-293
- Morbidity results from the NSABP-32 trial comparing sentinel lymph node dissection versus axillary dissection.J Surg Oncol. 2010; 102: 111-118
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Published online: May 11, 2012
Accepted: April 4, 2012
Received: April 3, 2012See accompanying article on page X. (Editorial will accompany article by Cluze et al. “Inequality in sentinal lymph node dissection for elderly women with early stage breast cancer: Results from a French prospective cohort study")
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.