Originally published as JCO Early Release 10.1200/JCO.2005.08.001 on September 12 2005

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American Society of Clinical Oncology Guideline Recommendations for Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer

From the University of Rochester School of Medicine and Dentistry, Rochester, NY; John Wayne Cancer Institute, Santa Monica, CA; Northwestern University, Evanston, IL; The University of Texas M.D. Anderson Cancer Center, Houston, TX; Dana-Farber Cancer Institute, Boston, MA; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; Roswell Park Cancer Institute, Buffalo, NY; Brigham and Women's Hospital, Boston, MA; University of Michigan, Ann Arbor, MI; Tufts-New England Medical Center, Boston, MA; the Susan G. Komen Breast Cancer Foundation, Dallas, TX; The University of Texas M.D. Anderson Cancer Center, Houston, TX; University of Kentucky, Lexington, KY; St John's Health Center, Santa Monica, CA; The Johns Hopkins University, Baltimore, MD; University of Vermont College of Medicine, Burlington, VT; Dana-Farber Cancer Institute, Boston, MA; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD

PURPOSE: To develop a guideline for the use of sentinel node biopsy (SNB) in early stage breast cancer.

METHODS: An American Society of Clinical Oncology (ASCO) Expert Panel conducted a systematic review of the literature available through February 2004 on the use of SNB in early-stage breast cancer. The panel developed a guideline for clinicians and patients regarding the appropriate use of a sentinel lymph node identification and sampling procedure from hereon referred to as SNB. The guideline was reviewed by selected experts in the field and the ASCO Health Services Committee and was approved by the ASCO Board of Directors.

RESULTS: The literature review identified one published prospective randomized controlled trial in which SNB was compared with axillary lymph node dissection (ALND), four limited meta-analyses, and 69 published single-institution and multicenter trials in which the test performance of SNB was evaluated with respect to the results of ALND (completion axillary dissection). There are currently no data on the effect of SLN biopsy on long-term survival of patients with breast cancer. However, a review of the available evidence demonstrates that, when performed by experienced clinicians, SNB appears to be a safe and acceptably accurate method for identifying early-stage breast cancer without involvement of the axillary lymph nodes.

CONCLUSION: SNB is an appropriate initial alternative to routine staging ALND for patients with early-stage breast cancer with clinically negative axillary nodes. Completion ALND remains standard treatment for patients with axillary metastases identified on SNB. Appropriately identified patients with negative results of SNB, when done under the direction of an experienced surgeon, need not have completion ALND. Isolated cancer cells detected by pathologic examination of the SLN with use of specialized techniques are currently of unknown clinical significance. Although such specialized techniques are often used, they are not a required part of SLN evaluation for breast cancer at this time. Data suggest that SNB is associated with less morbidity than ALND, but the comparative effects of these two approaches on tumor recurrence or patient survival are unknown.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

Address reprint requests to American Society of Clinical Oncology, Cancer Policy and Clinical Affairs, 1900 Duke St, Suite 200, Alexandria, VA 22314; e-mail: guidelines@asco.org.

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