[Sentinel node and breast cancer: A state-of-the-art in 2019]

Area of Science:

• Oncology
• Surgical Oncology
• Breast Cancer Management

Background:

• Sentinel lymph node (SLN) biopsy, introduced in 1994, is a cornerstone in breast cancer management.
• Neoadjuvant chemotherapy (NAC) improves regional control, particularly in axillary lymph nodes.
• Guidelines vary on the timing of SLN biopsy (before or after NAC) for N0 patients.

Purpose of the Study:

• To review literature on indications for SLN detection and axillary dissection (AD) in patients undergoing NAC.
• To explore different perspectives and studies on SLN status after NAC.
• To identify criteria for selecting patients for SLN procedures post-NAC.

Main Methods:

• Literature review of medical studies.
• Analysis of current recommendations from learned societies.
• Evaluation of prognostic factors and treatment outcomes.

Main Results:

• SLN detection before NAC is a significant prognostic factor, especially for initially node-positive (N+) patients.
• Complete pathological response (pCR) after NAC is emerging as a key criterion for SLN detection.
• Current recommendations do not universally support SLN biopsy in patients with initial lymph node involvement before NAC.

Conclusions:

• Complete pathological response after NAC is a critical factor in deciding on SLN biopsy to potentially avoid unnecessary axillary dissection.
• Further clinical trials are essential to refine recommendations for SLN procedures after NAC.
• Optimizing SLN use post-NAC can reduce rates of non-pathological axillary dissection.