Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer: ASCO Guideline Update

Area of Science:

• Oncology
• Surgical Oncology
• Breast Cancer Management

Background:

• Sentinel lymph node biopsy (SLNB) is a standard procedure for staging early-stage breast cancer.
• Evolving evidence necessitates updated recommendations for SLNB use and axillary lymph node dissection (ALND).

Purpose of the Study:

• To provide updated evidence-based recommendations on the use of SLNB in early-stage breast cancer patients undergoing initial surgery.
• To guide clinical decision-making regarding nodal staging and treatment in breast cancer.

Main Methods:

• A systematic literature review was conducted from January 2016 to May 2024.
• An Expert Panel convened by ASCO developed practice recommendations based on the review and informal consensus.

Main Results:

• Eleven randomized clinical trials, eight meta-analyses/systematic reviews, and one prospective cohort study were included.
• Recommendations address routine SLNB in specific patient groups, the use of postmastectomy radiation with regional nodal irradiation, and the omission of ALND in certain cases.

Conclusions:

• Routine SLNB is not advised for select postmenopausal patients with specific tumor characteristics undergoing breast-conserving therapy.
• ALND should not be recommended for patients with no nodal metastases or with one to two positive sentinel nodes undergoing specific surgical and radiation protocols.