How Does It Feel? Sentinel Node Biopsy Is Better

Excerpt

For nearly a century, axillary lymph node dissection (ALND) was part of the standard operation for most women undergoing surgical staging and treatment of breast cancer. This began to change precipitously after the report in 1998 by Krag et al.1 demonstrating that sentinel lymph node biopsy (SNB) for pathologically staging clinically node-negative breast cancer was feasible and accurate. After dozens of subsequent studies within several years, a paradigm shift in surgery has occurred such that by a mere 7 years after the initial Krag et al. report, an American Society of Clinical Oncology Expert Panel concluded that SNB is an appropriate initial alternative to routine staging ALND for patients with early-stage breast cancer with clinically disease-negative axillary nodes.2 Another example of such a dramatic shift in the surgical approach to one of the most common human malignancies would be hard to find. In the basis of Surveillance, Epidemiology, and End Results program registry data, breast cancer is newly diagnosed in >200,000 women in the United States annually, and with the success of early detection programs that use mammography along with clinical and self-breast examination, >60% are diagnosed while the cancer is still confined to the breast.3 Conservatively, then, >120,000 women a year in the United States alone can be spared the unnecessary morbidity of an ALND by undergoing an SNB that proves their breast cancer is a node-negative stage. …