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Sentinel Lymph Nodes for Breast Carcinoma: A Paradigm Shift
1From the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
Archives of Pathology & Laboratory Medicine
|July 30, 2016
Summary
Sentinel lymph node biopsy is standard for breast cancer staging. Axillary lymph node dissection can be omitted in select patients, improving care and pathology reporting for invasive breast carcinoma.
Area of Science:
- Oncology
- Surgical Pathology
- Breast Cancer Management
Background:
- Sentinel lymph node biopsy (SLNB) is the standard for axillary staging in invasive breast carcinoma.
- Historically, positive SLNB mandated axillary lymph node dissection (ALND).
- Recent evidence supports omitting ALND in specific early-stage breast cancer patients.
Purpose of the Study:
- Review clinical and pathologic studies on sentinel lymph nodes (SLNs).
- Determine how SLN findings impact pathologic evaluation and reporting.
- Inform practice changes regarding axillary staging in breast cancer.
Main Methods:
- Literature review of peer-reviewed articles from PubMed.
- Analysis of guidelines from major oncology organizations (AJCC, UICC, ASCO, NCCN).
Main Results:
- The primary goal of SLN examination is detecting macrometastases (>2 mm).
- Preferred pathologic evaluation involves gross sectioning of SLNs at 2-mm intervals and H&E staining.
- ALND can be omitted in node-negative patients and selected cases with limited SLN metastasis.
Conclusions:
- Pathologic features of primary tumors and SLN metastases help estimate non-SLN involvement.
- This estimation guides decisions on further axillary treatment.
- SLN examination refinement is crucial for optimizing breast cancer management.
