Sentinel lymph node in breast cancer.

PURPOSE OF REVIEW: Sentinel lymph node biopsy has become an accepted standard in staging axillary lymph nodes for breast cancer, but there are still unresolved questions regarding the application of the sentinel node procedure. The purpose of this review is to highlight recent developments in sentinel lymph node biopsy for breast cancer.

RECENT FINDINGS: Recent evidence has demonstrated that subareolar injection immediately before surgery is an acceptable and accurate alternative to peritumoral injection, and that lymphoscintigraphy is not always necessary. The use of sentinel lymph node biopsy with neoadjuvant chemotherapy and ductal carcinoma in situ continues to undergo investigation. Recently completed clinical trials will answer questions relating to the value of identifying isolated tumor cells in the sentinel node by immunohistochemistry, and the need for axillary node dissection when the sentinel node is positive.

SUMMARY: Sentinel lymph node biopsy is an accepted standard for stage I and II breast cancer, and is investigational with stage III cancer or with neoadjuvant therapy, as well as with ductal carcinoma in situ. Patients should be made aware of relevant issues as part of providing informed consent for surgery and subsequent therapy.