Sentinel node biopsy

Overview

• 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.