Sentinel Lymph Node: Clinicopathologic Features

  • Isabel Alvarado-Cabrero
  • Sergio A. Rodríguez-Cuevas


The sentinel lymph node (SLN) is frequently the first node in the lymphatic basin that receives drainage from an anatomic region and is immunologically responsible for that region. Sentinel lymph node biopsy (SLNB) remains the standard of care for the assessment of clinically negative axillary lymph nodes in patients with invasive breast carcinomas. Accurate diagnosis of a SLNB can direct the surgeon with regard to the need for axillary dissection (AD), and it can affect post-operative treatment decisions, including decisions about radiation therapy. Furthermore, an accurate negative diagnosis on SLNB can spare the patient the increased risk of lymphedema that accompanies AD or post-operative treatments. Its relatively low false negative rate of 5–10% and high sensitive rate of 90–95% in the detection of cancer to the lymph node basin has made this minimally invasive operation a standard. The idea that the SLN serves as a limited target sample of the axillary lymph nodes aroused an interest and trend toward increased inspection of the sentinel lymph node for detection of metastatic carcinoma by the pathologist though serial sections and/or immunohistochemistry.


Breast Carcinoma Axillary lymph nodes Staging Sentinel lymph node Biopsy 


  1. 1.
    Amin M, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK, et al., editors. The AJCC cancer staging manual. 8th ed. New York, NY: Springer International Publishing; 2017.Google Scholar
  2. 2.
    Giuliano AE, Kirgan DM, Guenther JM, Morton DL. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg. 1994;220:391–8.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Lyman GH, Giulano AE, Somerfield MR, Benson AB 3rd, Bodurka DC, Burstein HJ, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol. 2005;23:7703–20.CrossRefPubMedGoogle Scholar
  4. 4.
    McMaster KM, Tuttle TM, Carlson DJ, Brown CM, Noyes RD, Glaser RL, et al. Sentinel lymph node biopsy for breast cancer: a suitable alternative to routine axillary dissection in multi-institutional practice when optimal technique is used. J Clin Oncol. 2000;18:2560–6.CrossRefGoogle Scholar
  5. 5.
    Veronesi U, Viale G, Paganelly G, Zurrida S, Luini A, Galimberti V, et al. Sentinel lymph node biopsy in breast cancer: ten-year results of a randomized controlled study. Ann Surg. 2010;25:595–600.Google Scholar
  6. 6.
    Giuliano AE, Ballman K, Mc Call L, Beitsch P, Whitworth PW, Blumencranz P, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: long-term follow-up from the American College of Surgeons oncology group (alliance) ACOSOG Z 011 randomized trial. Ann Surg. 2016;264:413–20.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Chatterjee A, Serniak N, Czerniecki BJ. Sentinel lymph node biopsy in breast cancer: a work in progress. Cancer J. 2015;21:7–10.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Apple SK. Sentinel lymph node in breast cancer: review article from a pathologist’s point of view. J Pathol Transl Med. 2016;50:83–95.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Hansen NM, Grube BJ, Giulano AE. The time has come to change the algorithm for the surgical management of early breast cancer. Arch Surg. 2002;137:1131–5.CrossRefPubMedGoogle Scholar
  10. 10.
    Somasundaram SK, Chicken DW, Keshtgar M. Detection of the sentinel lymph node in breast cancer. Br Med Bull. 2007;84:117–31.CrossRefPubMedGoogle Scholar
  11. 11.
    McMasters KM, Wong SL, Martin RC 2nd, Chao C, Tuttle TM, Noyes RD, et al. Dermal injection of radioactive colloid is superior to peritumoral injection for breast cancer sentinel lymph node biopsy: results of a multiinstitutional study. Ann Surg. 2001;233:676–87.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Maguire A, Brogi E. Sentinel lymph nodes for breast carcinoma. A paradigm shift. Arch Pathol Lab Med. 2016;140:791–8.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Weaver DL. Sentinel lymph nodes and breast carcinoma: which micrometastases are clinically significant? Am J Surg Pathol. 2003;27:842–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Weaver DL, Ashikaga T, Krag DN, Skelly JM, Anderson SJ, Harlow SP, et al. Effect of occult metastases on survival in node-negative breast cancer. N Engl J Med. 2011;364:412–21.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Weaver DL, Le UP, Harlow SP, Ashikaga T, Krag DN, Dupuis SL, et al. Metastasis detection in sentinel lymph nodes comparison of a limited widely spaced (NSABP protocol B-32) and a comprehensive narrowly spaced paraffin block sectioning strategy. Am J Surg Pathol. 2009;33:1583–9.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Van der Noordaa MEM, MTFD V-P, EJT R. The intraoperative assessment of sentinel nodes—standards and controversies. Breast. 2017;34:S64–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Barroso-Bravo S, Zarco-Espinoza G, Alvarado-Cabrero I, Valenzuela-Flores AG, Pichardo-Romero P, Rodríguez-Cuevas S. Lymphatic mapping and sentinel lymph node biopsies in order to avoid axillary dissection in early breast cancer. Cir Cir. 2005;73:437–41.PubMedGoogle Scholar
  18. 18.
    Cox C, Centeno B, Dickson D, Clark J, Nicosia S, Dupont E, et al. Accuracy of Intraoperative imprint cytology for sentinel lymph node evaluation in the treatment of breast carcinoma. Cancer. 2005;105:13–20.CrossRefPubMedGoogle Scholar
  19. 19.
    Brogi E, Torres-Matundan E, Tan LK, Cody HS III. The results of frozen section, touch preparation, and cytological smear are comparable for intraoperative examination of sentinel lymph nodes: a study in 133 breast cancer patients. Ann Surg Oncol. 2005;12:173–80.CrossRefPubMedGoogle Scholar
  20. 20.
    Weaver DL. Pathology evaluation on sentinel lymph nodes in breast cancer: protocol recommendations and rationale. Mod Pathol. 2010;23:S26–32.CrossRefPubMedGoogle Scholar
  21. 21.
    Diaz LK, Hunt K, Ames F, Meric F, Kuerer H, Babiera G, et al. Histologic localization of sentinel lymph node metastases in breast cancer. Am J Surg Pathol. 2003;27:385–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Association of Directors of Anatomic and surgical Pathology. ADASP recommendations for processing and reporting lymph node specimens submitted for evaluation of metastatic disease. Am J Surg Pathol. 2001;25:961–3.CrossRefGoogle Scholar
  23. 23.
    Aziz S, Wik E, Knutsuik G, Klingen TA, Chen Y, Davidsen B, et al. Extra-nodal extension is a significant prognostic factor in lymph node positive breast cancer. PLoS One. 2017;15:e0171853.CrossRefGoogle Scholar
  24. 24.
    Cserni G. Axillary sentinel lymph node micrometastases with extracapsular extension: a distinct pattern of breast cancer metastasis? J Clin Pathol. 2008;61:115–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Xing Y, Foy M, Cox DD, Kuerer HM, Hunt KK, Cormier JN. Meta-analysis of sentinel lymph node biopsy after preoperative chemotherapy in patients with breast cancer. Br J Surg. 2006;93:539–46.CrossRefPubMedGoogle Scholar
  26. 26.
    Lyman GH, Temin S, Edge SB, Newman LA, Turner RR, Weaver DL, et al. Sentinel lymph node biopsy for patients with early-breast cancer: American Society of Clinical Oncology. Clinical practice guideline update. J Clin Oncol. 2014;32:1365–83.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Isabel Alvarado-Cabrero
    • 1
  • Sergio A. Rodríguez-Cuevas
    • 2
  1. 1.Department of Pathology, Hospital de Oncologia, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro SocialMexico CityMexico
  2. 2.Breast Institute, FUCAMMexico CityMexico

Personalised recommendations