title: Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update.
abstract: OBJECTIVE
  To provide evidence-based recommendations to practicing oncologists, surgeons, and radiation therapy clinicians to update the 2005 clinical practice guideline on the use of sentinel node biopsy (SNB) for patients with early-stage breast cancer.
  
  
  METHODS
  The American Society of Clinical Oncology convened an Update Committee of experts in medical oncology, pathology, radiation oncology, surgical oncology, guideline implementation, and advocacy. A systematic review of the literature was conducted from February 2004 to January 2013 in Medline. Guideline recommendations were based on the review of the evidence by Update Committee.
  
  
  RESULTS
  This guideline update reflects changes in practice since the 2005 guideline. Nine randomized clinical trials (RCTs) met systematic review criteria for clinical questions 1 and 2; 13 cohort studies informed clinical question 3.
  
  
  CONCLUSIONS
  Women without sentinel lymph node (SLN) metastases should not receive axillary lymph node dissection (ALND). Women with one to two metastatic SLNs planning to undergo breast-conserving surgery with whole-breast radiotherapy should not undergo ALND (in most cases). Women with SLN metastases who will undergo mastectomy should be offered ALND. These three recommendation are based on RCTs. Women with operable breast cancer and multicentric tumors, with ductal carcinoma in situ (DCIS) who will undergo mastectomy, who previously underwent breast and/or axillary surgery, or who received preoperative/neoadjuvant systemic therapy may be offered SNB. Women who have large or locally advanced invasive breast cancer (tumor size T3/T4), inflammatory breast cancer, or DCIS (when breast-conserving surgery is planned) or are pregnant should not undergo SNB. These recommendations are based on cohort studies and/or informal consensus. In some cases, updated evidence was insufficient to update previous recommendations.
authors.affiliation: Gary H. Lyman, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Sarah Temin, American Society of Clinical Oncology, Alexandria, VA; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; Lisa A. Newman and James Hayman, University of Michigan, Ann Arbor, MI; Roderick R. Turner, John Wayne Cancer Institute, Santa Monica; Linda D. Bosserman, Wilshire Oncology Medical Group, Rancho Cucamonga; Armando E. Giuliano, Cedars-Sinai Medical Center, Los Angeles, CA; Donald L. Weaver, University of Vermont College of Medicine and Vermont Cancer Center, Burlington, VT; Al B. Benson III, Northwestern University, Chicago, IL; Harold J. Burstein, Dana-Farber Cancer Institute, Boston, MA; Hiram Cody III, Memorial Sloan Kettering Cancer Center, New York, NY; Cheryl L. Perkins, Patient Representative, Dallas; and Donald A. Podoloff, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Gary H
authors.initials: GH
authors.lastname: Lyman
authors.forename: Sarah
authors.initials: S
authors.lastname: Temin
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Edge
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Newman
authors.forename: Roderick R
authors.initials: RR
authors.lastname: Turner
authors.forename: Donald L
authors.initials: DL
authors.lastname: Weaver
authors.forename: Al B
authors.initials: AB
authors.lastname: Benson
authors.forename: Linda D
authors.initials: LD
authors.lastname: Bosserman
authors.forename: Harold J
authors.initials: HJ
authors.lastname: Burstein
authors.forename: Hiram
authors.initials: H
authors.lastname: Cody
authors.forename: James
authors.initials: J
authors.lastname: Hayman
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Perkins
authors.forename: Donald A
authors.initials: DA
authors.lastname: Podoloff
authors.forename: Armando E
authors.initials: AE
authors.lastname: Giuliano
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008495:Medical Oncology / Q000592:standards*; D009367:Neoplasm Staging; D016032:Randomized Controlled Trials as Topic; D021701:Sentinel Lymph Node Biopsy / Q000379:methods* / Q000592:standards*