Recent advances in sentinel lymph node biopsy for breast cancer

Purpose of review: This article reviews the recent advancements and refinements of the sentinel lymph node (SLN) biopsy technique in breast cancer. Recent findings: Data from four randomized controlled trials conclusively demonstrate that SLN biopsy is associated with less arm morbidity and better quality of life than axillary lymph node dissection. Large observational studies have shown that SLN biopsy is associated with low local recurrence rate and similar survival to axillary lymph node dissection. Preoperative axillary ultrasound and fine-needle aspiration cytology has recently been shown to improve patient selection for sentinel node biopsy. Furthermore, intraoperative assessment of SLN can now be performed rapidly and accurately using the real time GeneSearch BLN Assay. There is accumulating evidence that SLN biopsy is applicable before or after neoadjuvant chemotherapy and remapping is feasible in patients who develop breast recurrence following breast conservation and SLN biopsy. Summary: SLN biopsy is the new standard of care for nodal staging in early-stage breast cancer patients and contraindications are decreasing with experience. However, the clinical relevance of SLN micrometastasis and isolated tumour cells remains unclear. Definitive data from randomized trials are needed to decide if axillary dissection is needed when the SLN is positive