title: Sentinel lymph node biopsy in breast cancer: a technical and clinical appraisal.
abstract: Breast cancer is the most common type of cancer diagnosed in women worldwide. Regional lymph node status is one of the strongest predictors of long-term prognosis in primary breast cancer. Sentinel lymph node biopsy (SLNB) has replaced axillary lymph node dissection as the standard surgical procedure for staging clinically tumor-free regional nodes in patients with early-stage breast cancer. SLNB staging considerably reduces surgical morbidity in terms of shoulder dysfunction and lymphedema, without affecting diagnostic accuracy and prognostic information. Clinicians should not recommend axillary lymph node dissection for women with early-stage breast cancer who have tumor-free findings on SLNB because there is no advantage in terms of overall survival and disease-free survival. Starting from the early 1990s, SLNB has increasingly been used in breast cancer management, but its role is still debated under many clinical circumstances. Moreover, there is still a lack of standardization of the basic technical details of the procedure that is likely to be responsible for the variability found in the false-negative rate of the procedure (5.5-16.7%). In this article, we report the aspects of SLNB that are well established, those that are still debated, and the advancements that have taken place over the last 20 years. We have provided an update on the methodology from both a technical and a clinical point of view in the light of the most recent publications.
authors.affiliation: aRegional Center of Nuclear Medicine, University Hospital of Pisa, Pisa bDepartment of Nuclear Medicine, Radiology, NeuroRadiology, Interventional Radiology, Medical Physics, Clinical Laboratory, Biomarkers Laboratory, Microbiology, Pathology, Santa Maria della Misericordia Hospital, Rovigo, Italy cDepartment of Cancer Imaging, Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas' Hospital, London, UK.
authors.forename: Gianpiero
authors.initials: G
authors.lastname: Manca
authors.forename: Elisa
authors.initials: E
authors.lastname: Tardelli
authors.forename: Domenico
authors.initials: D
authors.lastname: Rubello
authors.forename: Marta
authors.initials: M
authors.lastname: Gennaro
authors.forename: Maria Cristona
authors.initials: MC
authors.lastname: Marzola
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Cook
authors.forename: Duccio
authors.initials: D
authors.lastname: Volterrani
mesh_terms: D001365:Axilla; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods; D008207:Lymphatic Metastasis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D000071036:Sentinel Lymph Node / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D014055:Tomography, Emission-Computed / Q000379:methods*