Sentinel lymphadenectomy in node negative breast cancer

SLND, regardless of method, can precisely predict the status of the axillary lymph nodes. Despite differences in technique, the consistent results support the sentinel node hypothesis in breast cancer. The procedure is well tolerated, and staging can be achieved accurately with minimal morbidity. SLND is a minimally-invasive procedure that provides tissue for the pathologist that represents the site most likely to harbor metastases. If a negative sentinel node is removed at SLND, it equates to truly node-negative breast cancer in almost all cases when done by experienced surgeons familiar with the technique. SLND can be mastered by surgeons at several institutions, but requires appropriate training to learn the technique. The team involved in SLND, which consists of the surgeon, pathologist and nuclear medicine physician, must determine its own false negative rate for the procedure, which requires a concomitant ALND so that accuracy is validated. Multicenter randomized clinical trials from the American College of Surgeons and NSABP are in progress, which will evaluate in general, although with different randomization schemes, the outcome of patients who have SLND alone compared to those who have ALND. Before ALND is completely abandoned, these trials must be completed so that the role of SLND in the management of all patients with early breast cancer is fully defined.