Hernan Vargas, MD, FACS, a breast surgeon at Virginia Cancer Specialists, discusses the utility of sentinel lymph node biopsy in breast cancer.

Historically, complete axillary lymph node dissection was the standard surgical intervention for patients with lymph node involvement. However, the procedure can lead to lymphedema, range of motion difficulties, and chronic pain, says Vargas. Now, patients with lymph node involvement can undergo sentinel node biopsy, which is a less morbid procedure.

Eligibility criteria for this approach are based on initial therapeutic approaches, says Vargas. If a patient is treated with surgery up front, de-escalated approaches may be based on data from the ACOSOG Z0011 trial, which showed that a patient should have <3 positive nodes and no extranodal extension to be eligible for a de-escalated approach. Although the trial only looked at breast conservation candidates, these criteria may be applicable to patients who undergo mastectomy, as well, says Vargas.

For patients treated with neoadjuvant chemotherapy, the primary de-escalation criteria is their response to therapy. Secondly, surgeons who proceed with sentinel node biopsy should be able to identify the originally positive nodes. Although a number of patients can benefit from de-escalated approaches, there are those who need complete axillary dissection, concludes Vargas.

Hernan Vargas, MD, FACS

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Dr. Vargas on the Utility of Sentinel Node Biopsy in Breast Cancer