Dr Sarma on the Current Role of Sentinel Node Biopsies in Breast Cancer

“Almost any surgical procedure comes with risk, whether it’s pain, nerve injury, or vascular injury, [and] sentinel node lymph node biopsies have been associated with decreased range of motion [and] a small risk of lymphedema. The questions are: do we need to do sentinel node biopsies in all women with breast cancer? Can we possibly omit this without negatively [affecting] outcomes?”

Deba Sarma, MD, a breast surgical oncologist at the Atrium Health Levine Cancer Institute and an assistant professor of surgery at the Wake Forest University School of Medicine, highlighted the role of sentinel node biopsies for the treatment of patients with breast cancer.

When patients with breast cancer are diagnosed with invasive ductal carcinoma or lobular carcinoma, it typically can spread into the lymphatic system and axillary lymph nodes, Sarma began. She added that the first site of metastasis also commonly occurs in the ipsilateral lymph nodes. When patients are presumed to have breast cancer, they receive an ultrasound or mammogram imaging, she asserted. Patients could also receive an axillary ultrasound before biopsy. However, if an ultrasound demonstrates a negative result, then an axillary biopsy is not required, she said.

Nevertheless, the standard of care at the time of surgery—whether the procedure is a lumpectomy or mastectomy—a sentinel lymph node procedure is performed to remove the first 2 to 3 lymph nodes where metastases could be found, Sarma continued. Still, with this procedure comes associated risks, including pain, nerve injury, or vascular injury, she said. Furthermore, sentinel node biopsies could also be associated with a decreased range of motion and a small risk of lymphedema, according to Sarma. Several questions remain, including whether every patient with breast cancer requires a sentinel node biopsy, whether a sentinel node biopsy can be omitted without negatively affecting outcomes, and whether these decisions will not affect decisions made by medical oncologists, radiation oncologists, and other disciplines regarding surgical management.