Management of non-detection of the sentinel node in breast cancer: A scoping review

Axillary nodal status is a key prognostic factor in women with breast cancer and is most commonly assessed by sentinel lymph node biopsy (SLNB). However, non-detection of the sentinel node occurs in 1-13% of cases and remains insufficiently addressed in international clinical guidelines. This scoping review maps the existing evidence on axillary sampling (AS) as an alternative axillary staging strategy when the sentinel node cannot be identified. A structured literature search was conducted in PubMed to identify studies evaluating the diagnostic accuracy of AS in comparison with SLNB and axillary lymph node dissection (ALND) in clinically node-negative breast cancer. Nine studies, reported in ten publications, met the eligibility criteria. Across the included literature, AS demonstrated high sensitivity and low false-negative rates, particularly when four or more lymph nodes were removed. The diagnostic performance of AS was comparable to ALND and slightly inferior to SLNB. Overall, the available evidence suggests that AS may represent a feasible alternative for axillary staging in cases of sentinel node non-detection. However, the evidence base is limited and largely derived from older studies, highlighting the need for contemporary research to inform clinical practice and guideline development.