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ASCO Issues Updated Recommendations for Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer

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Key Points

  • A review by ASCO’s Update Committee of new data from randomized clinical trials has led to a change in recommendations for the use of sentinel lymph node biopsy in patients with early-stage breast cancer.
  • The updated guidelines will enable more women with early-stage breast cancer to avoid the more invasive axillary lymph node dissection, reducing their chances for complications.

A review by ASCO’s Update Committee of new data from randomized clinical trials has led to a change in recommendations for the use of sentinel lymph node biopsy in patients with early-stage breast cancer. The updated guideline will enable more women with early-stage breast cancer to avoid the more invasive axillary lymph node dissection, reducing their chances for complications. The new guideline is published in the Journal of Clinical Oncology.

The updated guideline reflects changes in practice since ASCO released its initial guideline in 2005. The revised guideline incorporates new evidence culled from nine randomized controlled trials and 13 cohort studies and reviewed by ASCO’s panel of experts in the fields of medical oncology, pathology, radiation oncology, surgical oncology, guideline implementation, and advocacy.

The axillary lymph node dissection procedure can cause long-term side effects, including pain and numbness in the arm and swelling from lymphedema. In sentinel lymph node biopsy, only a few lymph nodes are removed and examined for cancer, thus eliminating the need to remove additional lymph nodes if no cancer if found, and resulting in fewer side effects.

“Based on these studies, we’re saying more patients can safely get sentinel node biopsy without axillary lymph node dissection. These guidelines help determine for whom sentinel node biopsy is appropriate,” Armando Giuliano, MD, FACS, Co-Chair of ASCO’s Expert Panel, said in a statement.

Updated Recommendations

Recommendations based on evidence from randomized controlled trials include:

  • Women without sentinel lymph node metastases should not receive axillary lymph node dissection.
  • Most women with one to two metastatic sentinel lymph nodes planning to receive breast-conserving surgery with whole-breast radiotherapy should not undergo axillary lymph node dissection.
  • Women with sentinel lymph node metastases who will receive mastectomy may be offered axillary lymph node dissection.

Recommendations based on cohort studies and/or informal consensus:

  • Women with operable breast cancer and multicentric tumors, and/or ductal carcinoma in situ (DCIS) who will have mastectomy, and/or had prior breast and/or axillary surgery, and/or had preoperative/neoadjuvant systemic therapy may be offered sentinel lymph node biopsy.
  • Women who have large or locally advanced invasive breast cancers (tumor size T3/T4), and/or inflammatory breast cancer, and/or DCIS when breast-conserving surgery is planned, and/or are pregnant should not receive sentinel lymph node biopsy.

The committee members noted that in some cases, evidence was insufficient to update previous recommendations.

“We strongly encourage patients to talk with their surgeon and other members of their multidisciplinary team to understand their options and make sure everybody’s on the same page,” Gary Lyman, MD, MPH, FASCO, Co-Chair of the Expert Panel, said in a statement. “The most critical determinant of breast cancer prognosis is still the presence and extent of lymph node involvement and, therefore, the lymph nodes need to be evaluated so we can understand the extent of the disease.”

The study authors reported no potential conflicts of interest.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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