Intra-operative assessment of sentinel lymph nodes for breast cancer surgery: An update

Lymph node (LN) involvement is the strongest prognostic factor in operable breast cancer (BC). Therefore, accurate assessment of LN status is essential for management of BC patients. The introduction of sentinel LN approach reduced the need for extensive axillary surgery to achieve accurate staging. However, positive sentinel LN as determined on postoperative histological examination often leads to a second axillary operation to ensure an accurate staging and that positive non-sentinel LNs are removed. Although preoperative assessment of LN has improved significantly, its accuracy remains insufficient to avoid further axillary surgery and is not sufficient to predict the status of the LN. Therefore, intraoperative evaluation of the sentinel LN to determine the need for completing lymph node dissection in case of metastasis can provide an important approach to guide BC management decision making. This article reviews the techniques available and under development for intraoperative detection of sentinel LN metastasis in BC surgery. The key features of each technique are described in detail, emphasising the benefits offered by label-free optical techniques: minimal sample preparation, high spatial resolution, and immediate on-site implementation. Optical techniques have the potential to provide a cost-effective and accurate intraoperative platform for the assessment of SLN within the operating theatre.