Systemic treatment after sentinel lymph node biopsy in breast cancer: who, what, and why?

SLNB, although subject to numerous technical problems, has nonetheless shown great promise in predicting the status of the remaining axillary lymph nodes. The growing use of SLNB has presented the opportunity of using immunohistochemical and molecular markers to detect occult micrometastases. These micrometastases may be important for more accurate staging and prediction of patient outcomes. Current standards for the use of systemic therapy recommend multidrug chemotherapy for all but the most favorable disease (T1a/b, NO). The detection of micrometastases by SLNB in this low-risk group may change treatment recommendations to include systemic therapy. Because of the significant frequency of false-negative results in SLNB, which will depend upon the surgeon's experience, caution is urged in determining when ALND can be safely eliminated in patients with a negative SLNB.