The sentinel node negative axilla: is it a no-go zone?

The technique of sentinel node biopsy (SNB) presents a great opportunity to reduce the morbidity of surgical treatment of breast cancer. Using either dye, isotope or a combination, after completing a learning process a sensitivity of 80-99% may be achieved. Most surgeons would aim for a sensitivity of 95% but this will mean that 5% of patients will be under-staged, with disease within the axilla and possibly inappropriate advice with regard to adjuvant systemic therapy. Injudicious use of sentinel biopsy will lead to more local relapses and may diminish or neutralize gains from systemic therapy.