Sentinel node biopsy in breast cancer: ALMANAC trial

Sentinel node biopsy of breast cancer is becoming an increasingly popular t opic. The concept of the sentinel node being the first lymph node to contai n metastatic cancer within a tumor's lymphatic basin was introduced by Caba nas, a South American surgeon, following his work on carcinoma of the penis . Morton and his colleagues then applied this principle to malignant melano mas, and more recently this concept has gained popularity for carcinoma of the breast. In breast cancer patients, the fact that a sentinel node can be localized and the suggestion that the sentinel node is representative of t he axillary nodal status has been confirmed by a number of studies across t he world. Most authors writing on this subject, however, end with a caution that the results of randomized trials are needed before this new surgical technique can be accepted as part of routine breast cancer management. The Medical Research Council of the United Kingdom has funded the audit phase o f a multicenter, two phase, randomized trial called the Axillary Lymphatic Mapping Against Nodal Axillary Clearance (ALMANAC) trial, which will compar e standard axillary management with sentinel node-guided axillary managemen t, The aims and protocol of the trial are discussed in detail here.