JCO releases new sentinel node biopsy guidelines

Sentinel node biopsy for breast cancer patients is a safe alternative to full lymph-node dissection, according to new guidelines published online December 12 in the Journal of Clinical Oncology.

The new guidelines, which update those published in 2014, direct surgeons to forego routine axillary lymph-node dissection in women who have no evidence of cancer on sentinel node biopsy or if cancer is found in only one to two sentinel nodes. The majority of women receiving lumpectomy and whole-breast radiation can also forego a full lymph-node dissection -- an important benefit because axillary lymph-node dissection can lead to lymphedema, infections, reduced range of motion, and other painful and costly side effects (J Clin Oncol, December 12, 2016).

Sentinel node biopsy for breast cancer patients has been recommended as an alternative to full lymph-node dissection since 2014. However, surgeons are still performing the full dissection, said lead author Dr. Gary Lyman in a statement released by the Hutchinson Institute for Cancer Outcomes Research (HICOR), where Lyman is co-director.

"The [2014 guidelines] seem to have been embraced within academic centers and larger hospitals and cancer centers, but compliance is still quite variable elsewhere," Lyman said. "In smaller hospitals, particularly in rural areas, many women are still being told they need a full axillary dissection."

There are factors to take into consideration: The sentinel node biopsy has to be well-performed, the tumor should not be larger than 5 cm, and there should be no other major risk factors, Lyman said. But approximately two-thirds of women meet these criteria.

"This is part of an overall trend in the breast cancer setting to not do more than we need to, based on the evidence," Lyman said. "Of course, we're doing less and less extensive surgery -- from radical mastectomy to lumpectomy. And even now with lumpectomies, we're not taking more tissue than is really needed."