Sentinel node update: Breast cancer

Sentinel node biopsy in breast cancer is rapidly gaining acceptance as art appropriate diagnostic tool for determining whether cancer has spread to th e surrounding lymph nodes. Large studies have validated the accuracy of thi s technique. Many centers now offer sentinel node biopsy and bypass axillar y dissection if the sentinel node is negative. The National Comprehensive C ancer Network (NCCN) Breast Cancer Practice Guidelines Committee added stan dards for sentinel node biopsy to their guidelines irt 1997 as a category 2 recommendation. Their suggestions address the criteria for patient selecti on, ana the need for art experienced team of practitioners. Despite the rap id acceptance and proliferation of the technique, many questions remain reg arding its use. They include defining the optimal material and technique to identify the sentinel node, patient selection, the role of biopsy of nonax illary sentinel nodes, the role of immunohistochemical analysis of nodes to identify micrometastases, the situations under which complete axillary nod e dissection is indicated, and finally whether axillary dissection in the s entinel node-negative patient impacts survival. To address these questions, the American. College of Surgeons Oncology Group and the National Surgical Adjuvant Breast and Bowel Project recently activated large-scale clinical trials of sentinel node biopsy in breast cancer: Oncologists in all discipl ines should lend strong support to these protocols in the coming years.