{"entity":{"id":"sentinel-lymph-node-biopsy","kind":"term","name":"Sentinel node biopsy","aka":["sentinel lymph node biopsy","sentinel lymph node","sentinel node","sentinel lymph node mapping","SLNB"],"tldr":"Finding and removing the first one or two lymph nodes a tumour drains to, to see whether cancer has spread, instead of removing the whole nodal basin.","summary":"A dye or radioactive tracer (technetium tilmanocept, indocyanine green, blue dye) injected at the tumour travels to the 'sentinel' node, which is removed and examined. If it is clear, the remaining nodes are almost certainly clear and a full dissection with its lymphoedema risk is avoided. Standard in breast cancer, melanoma (from ~0.8 mm Breslow), endometrial and vulval cancers and increasingly oral cavity cancer; even positive sentinel nodes often no longer trigger full axillary dissection (Z0011, SENOMAC).","asOf":"2026-09-09","wikipedia":"https://en.wikipedia.org/wiki/Sentinel_lymph_node","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Sentinel_lymph_node"},{"label":"NICE NG101: early and locally advanced breast cancer, recommendations (updated 2025)","url":"https://www.nice.org.uk/guidance/ng101/chapter/Recommendations"},{"label":"Macmillan: surgery to the lymph nodes for breast cancer","url":"https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/surgery-to-the-lymph-nodes-for-breast-cancer"},{"label":"DiSipio et al., incidence of unilateral arm lymphoedema after breast cancer: systematic review and meta-analysis (Lancet Oncology 2013)","url":"https://doi.org/10.1016/S1470-2045(13)70076-7"},{"label":"Reimer et al., axillary surgery in breast cancer, primary results of the INSEMA trial (NEJM 2025)","url":"https://doi.org/10.1056/NEJMoa2412063"}],"tags":[],"related":["lymphadenectomy","lymph-node-status","tilmanocept-tc99m","axillary-surgery-de-escalation","targeted-axillary-dissection","breast-cancer-related-lymphoedema"],"cancers":["breast-cancer"],"sections":["surgery"],"technologies":["sentinel-node","fluorescence-guided-surgery"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":["nsabp-b32","almanac","acosog-z0011","senomac","sound","insema","acosog-z1071"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":["Breast cancer: NICE NG101 (1.4.9) says to stage the axilla with sentinel lymph node biopsy rather than axillary lymph node clearance for people with invasive breast cancer who have no evidence of lymph node involvement on ultrasound or a negative ultrasound-guided needle biopsy, and (1.4.10) to perform it using the dual technique with isotope and blue dye. Macmillan says surgeons remove the smallest number of nodes possible, usually 1 to 3, which reduces the risk of arm swelling and shoulder stiffness.","What it saves. In the pooled prospective cohorts of the DiSipio meta-analysis, arm lymphoedema affected 5.6 percent of women after sentinel node biopsy against 19.9 percent after axillary lymph node dissection.","Where even a sentinel node biopsy may be avoidable. In INSEMA, 4,858 patients in the per-protocol analysis with clinically node-negative T1 or T2 cancer having breast-conserving surgery were randomised between omitting axillary surgery and sentinel node biopsy; 5-year invasive disease-free survival was 91.9 percent with omission and 91.7 percent with surgery (hazard ratio 0.91), and the omission group had less lymphoedema, greater arm mobility and less pain on moving the arm or shoulder. This is a trial result rather than a UK recommendation, and NG101 still asks for sentinel node biopsy."],"category":"Procedures"},"route":"/terms/sentinel-lymph-node-biopsy/","neighbours":{"term":[{"id":"cording-axillary-web-syndrome","kind":"term","name":"Cording (axillary web syndrome)","route":"/terms/cording-axillary-web-syndrome/"},{"id":"depth-of-invasion","kind":"term","name":"Depth of invasion (DOI)","route":"/terms/depth-of-invasion/"},{"id":"axillary-surgery-de-escalation","kind":"term","name":"Doing less to the armpit","route":"/terms/axillary-surgery-de-escalation/"},{"id":"terminal-duct-lobular-unit","kind":"term","name":"Ducts, lobules and the terminal duct lobular unit","route":"/terms/terminal-duct-lobular-unit/"},{"id":"hysterectomy","kind":"term","name":"Hysterectomy","route":"/terms/hysterectomy/"},{"id":"lymph-node-status","kind":"term","name":"Lymph node status (node-positive / node-negative)","route":"/terms/lymph-node-status/"},{"id":"lymphadenectomy","kind":"term","name":"Lymphadenectomy (lymph node dissection)","route":"/terms/lymphadenectomy/"},{"id":"breast-cancer-related-lymphoedema","kind":"term","name":"Lymphoedema after breast cancer treatment","route":"/terms/breast-cancer-related-lymphoedema/"},{"id":"lymphoedema-after-breast-cancer","kind":"term","name":"Lymphoedema after breast cancer treatment","route":"/terms/lymphoedema-after-breast-cancer/"},{"id":"mastectomy","kind":"term","name":"Mastectomy","route":"/terms/mastectomy/"},{"id":"targeted-axillary-dissection","kind":"term","name":"Targeted axillary dissection","route":"/terms/targeted-axillary-dissection/"}],"drug":[{"id":"tilmanocept-tc99m","kind":"drug","name":"Technetium-99m tilmanocept","route":"/drugs/tilmanocept-tc99m/"}],"cancer":[{"id":"breast-cancer","kind":"cancer","name":"Breast cancer (all types)","route":"/cancers/breast-cancer/"},{"id":"skin-cancer","kind":"cancer","name":"Skin cancer (all types)","route":"/cancers/skin-cancer/"},{"id":"tnbc","kind":"cancer","name":"Triple-negative breast cancer (TNBC)","route":"/cancers/tnbc/"}],"section":[{"id":"surgery","kind":"section","name":"Surgery & Interventional","route":"/fronts/surgery/"}],"technology":[{"id":"fluorescence-guided-surgery","kind":"technology","name":"Fluorescence-guided surgery","route":"/technologies/fluorescence-guided-surgery/"},{"id":"sentinel-node","kind":"technology","name":"Sentinel lymph node biopsy","route":"/technologies/sentinel-node/"}],"trial":[{"id":"acosog-z0011","kind":"trial","name":"ACOSOG Z0011 (Alliance)","route":"/trials/acosog-z0011/"},{"id":"acosog-z1071","kind":"trial","name":"ACOSOG Z1071 (Alliance)","route":"/trials/acosog-z1071/"},{"id":"almanac","kind":"trial","name":"ALMANAC (Axillary Lymphatic Mapping Against Nodal Axillary Clearance)","route":"/trials/almanac/"},{"id":"amaros","kind":"trial","name":"AMAROS (EORTC 10981-22023)","route":"/trials/amaros/"},{"id":"atnec","kind":"trial","name":"ATNEC","route":"/trials/atnec/"},{"id":"ibcsg-23-01","kind":"trial","name":"IBCSG 23-01","route":"/trials/ibcsg-23-01/"},{"id":"insema","kind":"trial","name":"INSEMA (Intergroup Sentinel Mamma)","route":"/trials/insema/"},{"id":"nsabp-b32","kind":"trial","name":"NSABP B-32","route":"/trials/nsabp-b32/"},{"id":"posnoc","kind":"trial","name":"POSNOC","route":"/trials/posnoc/"},{"id":"senomac","kind":"trial","name":"SENOMAC","route":"/trials/senomac/"},{"id":"sound","kind":"trial","name":"SOUND (Sentinel Node vs Observation After Axillary Ultra-Sound)","route":"/trials/sound/"},{"id":"targeted-axillary-dissection-md-anderson","kind":"trial","name":"Targeted axillary dissection (MD Anderson prospective study)","route":"/trials/targeted-axillary-dissection-md-anderson/"}]}}