A critique of the sentinel node concept.
The concept of "the sentinel node" is false. In the axilla, the lymphatic system usually first drains into a group of low axillary nodes (level 1). The validity, as a staging procedure, of a 4 node axillary sample was demonstrated 30 years ago by Prof. Sir Patrick Forrest. Sentinel node biopsy (SNB) should not become the standard of care for all breast cancer patients. All the various options (axillary sampling, SNB, axillary dissection or simply a watchful attitude) are acceptable and to be advised according to the patient's wishes and conditions and to the tumour characteristics. We would also propose the change of the terminology from SNB to "guided axilary sampling" (GAS).
Querci Della Rovere
G
G
The Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, UK. gquercidellarovere@doctors.org.uk
Benson
J R
JR
D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008208:Lymphatic System / Q000503:physiopathology*; D015203:Reproducibility of Results; D021701:Sentinel Lymph Node Biopsy