Our Summary

This research paper is about updated guidelines for the use of sentinel lymph node biopsy (SLNB), a procedure used to determine if breast cancer has spread to the lymph nodes, in patients with early-stage breast cancer. The guidelines were developed by a panel of experts who reviewed literature from 2016 to 2024.

According to the new guidelines, doctors should not routinely recommend SLNB for certain patients who are over 50, postmenopausal, and have early-stage, hormone receptor-positive breast cancer that has not spread to the lymph nodes (as per ultrasound results). These patients should have small tumors (2 cm or less) and be undergoing breast-conserving therapy.

The guidelines also suggest that doctors can offer radiation therapy after a mastectomy (removal of the breast) and skip the removal of additional lymph nodes in patients with invasive breast cancer that has not spread beyond one or two sentinel nodes.

The guidelines also state that doctors may recommend SLNB in patients with larger or multicentric tumors, those who are obese, male, or pregnant, or those who previously had breast or axillary surgery.

Doctors should not recommend removing additional lymph nodes in patients with early-stage breast cancer who do not have cancer in the lymph nodes, or those who have one or two sentinel lymph nodes with cancer but will receive radiation therapy for the whole breast.

These guidelines have been endorsed by the American Society for Radiation Oncology.

FAQs

  1. Who should not routinely undergo a sentinel lymph node biopsy according to the updated guidelines?
  2. In what cases can doctors skip the removal of additional lymph nodes in patients with invasive breast cancer?
  3. Who can doctors recommend sentinel lymph node biopsy for according to the new guidelines?

Doctor’s Tip

A helpful tip a doctor might tell a patient about sentinel lymph node biopsy is that it is a minimally invasive procedure that can help determine if the cancer has spread to the lymph nodes, which is important for treatment planning. It is important to discuss the risks and benefits of SLNB with your doctor and follow their recommendations based on your individual situation and cancer characteristics.

Suitable For

In summary, patients who are typically recommended for sentinel lymph node biopsy include those with larger or multicentric tumors, those who are obese, male, pregnant, or have had previous breast or axillary surgery. Additionally, patients who are younger, premenopausal, or have hormone receptor-negative breast cancer may also be recommended for SLNB. It is important for doctors to carefully consider each patient’s individual characteristics and breast cancer characteristics when determining if SLNB is appropriate.

Timeline

  • Before SLNB:
  1. Patient is diagnosed with early-stage breast cancer.
  2. Patient undergoes imaging tests (such as ultrasound) to determine if cancer has spread to the lymph nodes.
  3. Patient meets with their doctor to discuss treatment options, including the possibility of SLNB.
  4. If SLNB is recommended, patient undergoes a preoperative lymphoscintigraphy to map the sentinel lymph node(s).
  • After SLNB:
  1. Patient undergoes SLNB surgery, where a radioactive dye or tracer is injected near the tumor to identify the sentinel lymph node(s).
  2. The sentinel lymph node(s) is removed and tested for cancer cells.
  3. If cancer is found in the sentinel lymph node(s), further treatment options such as additional lymph node removal or radiation therapy may be recommended.
  4. If no cancer is found in the sentinel lymph node(s), the patient may not need further lymph node surgery or radiation therapy.
  5. Patient continues with their breast cancer treatment plan as determined by their healthcare team.

What to Ask Your Doctor

Some questions a patient should ask their doctor about sentinel lymph node biopsy include:

  1. Is a sentinel lymph node biopsy necessary for my specific type and stage of breast cancer?
  2. What are the potential risks and complications associated with a sentinel lymph node biopsy?
  3. Will the results of the biopsy affect my treatment plan?
  4. How will the results of the biopsy impact my prognosis?
  5. Are there alternative options to a sentinel lymph node biopsy that I should consider?
  6. Will I need additional treatment, such as radiation therapy, if cancer is found in the sentinel lymph node?
  7. How will the biopsy results be used to determine my overall treatment plan?
  8. Are there any specific criteria that make me a good candidate for a sentinel lymph node biopsy?
  9. What is the recovery process like after a sentinel lymph node biopsy?
  10. How often will I need follow-up appointments or tests after the biopsy procedure?

Reference

Authors: Park KU, Somerfield MR, Anne N, Brackstone M, Conlin AK, Couto HL, Dengel LT, Eisen A, Harvey BE, Hawley J, Kim JN, Lasebikan N, McDonald ES, Pradhan D, Shams S, Vega RM, Thompson AM, Torres MA. Journal: J Clin Oncol. 2025 May 10;43(14):1720-1741. doi: 10.1200/JCO-25-00099. Epub 2025 Apr 10. PMID: 40209128