Sentinel lymph nodes for breast carcinoma: an update on current practice

• Published in: Histopathology Vol. 68; no. 1; pp. 152 - 167
• Main Authors: Maguire, Aoife, Brogi, Edi
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-01-2016; Wiley Subscription Services, Inc
• Subjects: Antineoplastic Agents - therapeutic use; breast carcinoma; Breast Neoplasms - drug therapy; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Chemotherapy, Adjuvant; Female; Humans; Lymph Node Excision; Lymph Nodes - pathology; Lymphatic Metastasis - pathology; neoadjuvant chemotherapy; Neoadjuvant Therapy; Practice Patterns, Physicians; sentinel lymph node; Sentinel Lymph Node Biopsy - methods; neoadjuvant chemotherapy; breast carcinoma; sentinel lymph node
• ISSN: 0309-0167; 1365-2559
• DOI: 10.1111/his.12853

Sentinel lymph node (SLN) biopsy has been established as the standard of care for axillary staging in patients with invasive breast carcinoma and clinically negative lymph nodes (cN0). Historically, all patients with a positive SLN underwent axillary lymph node dissection (ALND). The ACOSOG Z0011 trial showed that women with T1–T2 disease and cN0 who undergo breast‐conserving surgery and whole‐breast radiotherapy can safely avoid ALND. The main goal of SLN examination should be to detect all macrometastases (>2 mm). Gross sectioning of SLNs at 2‐mm intervals and microscopic examination of one haematoxylin and eosin‐stained section from each SLN block is the preferred method for pathological evaluation of SLNs. The role and timing of SLN biopsy for patients who have received neoadjuvant chemotherapy is controversial, and continues to be explored in clinical trials. SLN biopsies from patients with invasive breast carcinoma who have received neoadjuvant chemotherapy pose particular challenges for pathologists.