Management strategy of early-stage breast cancer patients with a positive sentinel lymph node: With or without axillary lymph node dissection

Sentinel lymph node biopsy (SLNB) has been generally adopted as an alternative procedure to axillary lymph node dissection (ALND) for node staging. ALND remains the standard management of the axilla when a tumor-positive sentinel lymph node (SLN) is identified. However, further analysis has demonstrated that in 40-70% of cases with metastasis to the axillary lymph nodes, the SLN is the only positive node. Therefore, the traditional recommendation that ALND is always necessary for management of early-stage breast cancer patients with a positive SLN should be re-evaluated. Several nomograms and scoring systems have been developed to calculate the probability of non-SLN involvement on the basis of several clinicopathological variables. However, the actual value of such nomograms or scoring systems in daily clinical practice should be evaluated. This review focuses on the above topics and pushes forward the current heated debate on the management of early-stage breast cancer patients with a positive SLN.