American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer.
OBJECTIVE
To develop a guideline for the use of sentinel node biopsy (SNB) in early stage breast cancer.


METHODS
An American Society of Clinical Oncology (ASCO) Expert Panel conducted a systematic review of the literature available through February 2004 on the use of SNB in early-stage breast cancer. The panel developed a guideline for clinicians and patients regarding the appropriate use of a sentinel lymph node identification and sampling procedure from hereon referred to as SNB. The guideline was reviewed by selected experts in the field and the ASCO Health Services Committee and was approved by the ASCO Board of Directors.


RESULTS
The literature review identified one published prospective randomized controlled trial in which SNB was compared with axillary lymph node dissection (ALND), four limited meta-analyses, and 69 published single-institution and multicenter trials in which the test performance of SNB was evaluated with respect to the results of ALND (completion axillary dissection). There are currently no data on the effect of SLN biopsy on long-term survival of patients with breast cancer. However, a review of the available evidence demonstrates that, when performed by experienced clinicians, SNB appears to be a safe and acceptably accurate method for identifying early-stage breast cancer without involvement of the axillary lymph nodes.


CONCLUSIONS
SNB is an appropriate initial alternative to routine staging ALND for patients with early-stage breast cancer with clinically negative axillary nodes. Completion ALND remains standard treatment for patients with axillary metastases identified on SNB. Appropriately identified patients with negative results of SNB, when done under the direction of an experienced surgeon, need not have completion ALND. Isolated cancer cells detected by pathologic examination of the SLN with use of specialized techniques are currently of unknown clinical significance. Although such specialized techniques are often used, they are not a required part of SLN evaluation for breast cancer at this time. Data suggest that SNB is associated with less morbidity than ALND, but the comparative effects of these two approaches on tumor recurrence or patient survival are unknown.
Lyman
Gary H
GH
University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. guidelines@asco.org
Giuliano
Armando E
AE
Somerfield
Mark R
MR
Benson
Al B
AB
Bodurka
Diane C
DC
Burstein
Harold J
HJ
Cochran
Alistair J
AJ
Cody
Hiram S
HS
Edge
Stephen B
SB
Galper
Sharon
S
Hayman
James A
JA
Kim
Theodore Y
TY
Perkins
Cheryl L
CL
Podoloff
Donald A
DA
Sivasubramaniam
Visa Haran
VH
Turner
Roderick R
RR
Wahl
Richard
R
Weaver
Donald L
DL
Wolff
Antonio C
AC
Winer
Eric P
EP
D001943:Breast Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D015412:Mastectomy, Segmental; D015201:Meta-Analysis as Topic; D011788:Quality of Life; D021701:Sentinel Lymph Node Biopsy; D015996:Survival Rate