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Sentinel Lymphadenectomy in Breast Cancer

  • Hannah W. Hazard
  • Nora M. Hansen
Part of the Cancer Treatment and Research book series (CTAR, volume 141)

An estimated 178,480 people in the United States will be diagnosed with and 40,460 will die from breast cancer in 2007.With the institution of screening mammography guidelines between 1980 and 1987, there was a doubling in the incidence of small breast cancers (≤ 2 cm) with a concomitant decrease by 27% in the incidence of larger breast cancers (≥ 3 cm). As a greater percentage of breast cancers are being diagnosed at an earlier stage, the medical community has been challenged to develop diagnostic and treatment modalities that maximize benefit from therapy while reducing the morbidity associated with treatment. The management of breast cancer has changed dramatically in the last two decades with improvements in systemic therapy and advances in surgical techniques.

The single greatest predictor of overall survival for women diagnosed with operable breast cancer is the presence or absence of lymph node metastasis. Traditionally, axillary staging was performed with Level I and II axillary lymph node dissection (ALND). This identified women with poorer prognosis and greater risk of recurrence while helping direct their adjuvant therapy. Unfortunately, ALND for axillary staging in breast cancer carries a relatively high risk of secondary lymphedema as well as other morbidities such as parethesias and limited arm mobility. The concept of the sentinel lymph node (SLN) is based on the knowledge that there is an orderly progression of lymph drainage from the tumor via the lymphatic system to the dominant lymph basin of the affected area. Sentinel lymph node biopsy (SLNB) was established by Morton et al and was found to be an accurate technique in identifying nodal metastasis in malignant melanoma. The authors were able to avoid the associated morbidities of complete lymphadenectomy for early stage extremity melanoma. In breast cancer, tumor cells shed from the primary breast lesion progress along the lymphatic channels to the first draining lymph nodes in the axilla. By mapping the lymphatic drainage of the breast, the sentinel node can be identified, removed and evaluated for evidence of metastatic disease. As the number of tumors detected by imaging modalities alone increases, patients are being diagnosed with early stage breast cancer and therefore have a lower probability of axillary metastasis. The development of a less invasive method to evaluate the axilla and thereby reduce the risk of the morbidities associated with ALND was a logical next step in the treatment of breast cancer.

Keywords

Sentinel Lymph Node Sentinel Lymph Node Biopsy Axillary Lymph Node Dissection False Negative Rate Inflammatory Breast Cancer 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Hannah W. Hazard
    • 1
  • Nora M. Hansen
    • 1
  1. 1.Lynn Sage Comprehensive Breast CenterNorthwestern University School of MedicineChicagoUSA

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