Editorial: Sentinel Node Biopsy for Breast Cancer: Past, Present, and Future

Excerpt

It was 1898 when William Halsted presented his data on radical mastectomy to the American Surgical Association in New Orleans. For almost 70 years following this presentation this disfiguring operation was the mainstay of the treatment of breast cancer. After much debate in the surgical literature, modified radical mastectomy became popular and acceptable and did, of course, include complete axillary lymph node dissection (CALND). When lumpectomy became established as appropriate treatment, CALND continued as a part of that treatment until the 1990 s, when sentinel node identification was described by Morton for stage I cutaneous melanoma and subsequently applied to the treatment of breast cancer by Krag and Giuliano.1‐4 Large clinical trials including the National Surgical Adjuvant Breast and Bowel Project (NSABP) B32 and the American College of Surgeons Oncology Group (ACOSOG Z0010 studies have firmly established sentinel lymph node biopsy (SLNB) as an accurate method for axillary staging. The technique has been optimized and widely disseminated and now represents the standard of care as part of surgical management of invasive breast cancer. Surgical scientists continue to advance our understanding of the management of the axilla, with indications for CALND progressively diminishing. This trend was prophetically predicted by Blake Cady in 1984 when he stated that “Lymph node metastases are indicators and not governors of distant metastases.” …