Who Is a Good Candidate for Sentinel Lymph Node Dissection?

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Sentinel lymph node dissection is a good option for women with early-stage, invasive breast cancer who have a low to moderate risk of lymph node involvement.

In these women, it is critical to find out if the cancer has moved beyond the breast. But it also makes sense to remove only the few lymph nodes most likely to provide the key information.

In 2014, the American Society of Clinical Oncology released updated guidelines on sentinel lymph node biopsy for people diagnosed with early-stage breast cancer. These guidelines say sentinel node biopsy SHOULD be offered under the following circumstances:

  • breast cancer in which there is more than one tumor, all of which have formed separately from one another (doctors call these multicentric tumors); these types of breast cancers are rare
  • DCIS treated with mastectomy
  • women who have previously had breast cancer surgery or axillary lymph node surgery
  • women who have been treated before with chemotherapy or another systemic treatment (treatment before surgery is called neoadjuvant treatment)

Sentinel node biopsy SHOULD NOT be offered under these circumstances:

  • the cancer is 5 cm or larger or locally advanced (the cancer has spread extensively in the breast or to the nearby lymph nodes)
  • the cancer is inflammatory breast cancer
  • DCIS treated with lumpectomy
  • the woman is pregnant

The guidelines also say:

  • Women with negative sentinel node biopsies shouldn’t have axillary node surgery.
  • Women with one or two positive sentinel nodes who plan to have lumpectomy plus radiation also don’t need axillary node surgery.
  • Women who have one or more positive sentinel nodes and plan to have mastectomy with no radiation should be offered axillary node surgery.

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