Sentinel node dissection in early-stage breast cancer: ongoing prospective randomized trials in the USA

One of the most important advances in the surgical treatment of early-stage breast cancer has been the introduction of sentinel lymph node dissection as an alternative to routine axillary node dissection. This minimally invasive procedure may reduce the morbidity of surgical treatment and improve staging of the axillary lymph node basin. Over the last 5 to 7 years, numerous institutions have published their sentinel node identification rates, false-negative events, optimal techniques, and learning curves. Many of these issues need confirmation in a prospective multicentered fashion and other issues such as survival and comparative toxicities require prospective randomized trials. Two prospective randomized trials using sentinel node biopsy have been implemented in the United States: the NSABP B-32 trial and the ACOSOG Z0010/Z0011 trials. Design, hypotheses, and rationale for these trials are discussed.