Comprehensive review of sentinel lymphadenectomy in breast cancer

Sentinel lymph node dissection (SLND) is a minimally invasive technique to stage axillary lymph nodes in breast cancer. The complications associated with SLND are minimal, especially when compared to routine axillary lymph node dissection (ALND), and it can be performed with an overall identification rate of greater than 90% and a false-negative rate less than 5%. Despite this, SLND is not ready to replace routine axillary dissection, since we have no long-term results for these patients. What the clinical recurrence rates will be in women who undergo SLND only and how that will translate into survival rates has yet to be discovered. SLND is also a difficult technique to perform, as documented in the early SLND studies. It is imperative that each individual surgeon perform a series of cases in which SLND is combined with immediate ALND, so that identification rates and false-negative rates can be determined. Once a track record of successfully performed SLND has been established, SLND can be solely used for node-negative women. It is strongly recommended that all surgeons join one of the National Cancer Institute (NCI)-sponsored clinical trials for SLND in early breast cancer, so that many of these questions concerning SLND can finally be answered.