[Positive developments for patients with breast cancer as a result of the sentinel node biopsy procedure]

As an increasing number of large prospective studies show a high accuracy of the sentinel node for the staging of the axilla in women with invasive breast cancer, there is no need to test the value of this new technique in a randomised trial. Much more emphasis should be given to a reliable implementation of the technique in general practice, requiring a closely co-operating multidisciplinary team meticulously performing the different steps of the technique. The guidelines designed by the Dutch Working Group on the Sentinel Node in Breast Cancer include a learning phase of--arbitrarily--50 procedures in patients also undergoing a complete axillary dissection. What remains is the need for a treatment trial aimed at reducing the morbidity of the treatment of axillary metastases while retaining equal regional tumour control and patient survival. As the indication for adjuvant systemic treatment has shifted from the N-stage to T-stage parameters (size, grade, mitotic activity), the axillary nodal status has become less important as a staging tool. Thus, comparison of surgery or radiotherapy of sentinel node positive patients in a randomised trial appears to be a logical next step.