Sentinel Lymph Node Evaluation in Breast Cancer
Summary
The detection and analysis of sentinel lymph nodes (SLNs) have transformed axillary staging in breast cancer. By identifying the first draining lymph node, clinicians can determine nodal involvement with minimal surgical morbidity compared with full axillary lymph node dissection. Techniques such as dual-tracer mapping with blue dye, radioisotopes or fluorescence guidance have improved detection rates and reduced false negatives. The rise of neoadjuvant chemotherapy has introduced the concept of restaging the axilla after systemic treatment, guiding decisions on surgical de-escalation in exceptional responders. Emerging approaches employ image-guided localisation, novel tracers and targeted axillary dissection to identify residual disease, allowing tailored management that balances oncological safety with reduced morbidity. Current research explores the omission of any axillary surgery in low-risk patients, integration of radiotherapy as an alternative to dissection and the predictive value of pathological complete response. Global trials are refining criteria for de-escalated strategies, underscoring the shift towards personalised, less invasive axillary care in early breast cancer.
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Sentinel Lymph Node Evaluation in Breast Cancer publication trend
The graph below shows the total number of articles in sentinel lymph node evaluation in breast cancer across all publications each year (not limited to Nature Index journals).
Technical terms
Sentinel lymph node biopsy (SLNB): A surgical procedure to identify and remove the first lymph node(s) draining the tumour for pathological examination.
Axillary lymph node dissection (ALND): Removal of multiple lymph nodes from the axilla to assess and treat nodal metastases, associated with higher morbidity.
Pathological complete response (pCR): Absence of residual invasive cancer in the breast and axillary nodes following neoadjuvant therapy.
Neoadjuvant chemotherapy (NAC): Systemic drug treatment given before surgery to shrink tumours and eradicate micrometastases.
Contrast-enhanced ultrasound (CEUS): An imaging technique using microbubble contrast agents to visualise lymphatic flow and identify sentinel nodes.
References
- Sentinel Lymph Node Biopsy vs No Axillary Surgery in Patients With Small Breast Cancer and Negative Results on Ultrasonography of Axillary Lymph Nodes. JAMA Oncology (2023).
- Uncertainties and controversies in axillary management of patients with breast cancer. Cancer Treatment Reviews (2023).
- Selective elimination of breast cancer surgery in exceptional responders: historical perspective and current trials. Breast Cancer Research (2016).
- Comparison of sentinel lymph node biopsy guided by indocyanine green, blue dye, and their combination in breast cancer patients: a prospective cohort study. World Journal of Surgical Oncology (2017).
- Tailored axillary surgery with or without axillary lymph node dissection followed by radiotherapy in patients with clinically node-positive breast cancer (TAXIS): study protocol for a multicenter, randomized phase-III trial. Trials (2018).
- Intradermal microbubbles and contrast-enhanced ultrasound (CEUS) is a feasible approach for sentinel lymph node identification in early-stage breast cancer. World Journal of Surgical Oncology (2015).
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