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ASCO Makes No Changes to 2014 Recommendations for Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer

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As reported in the Journal of Clinical Oncology by Gary H. Lyman, MD, of Fred Hutchinson Cancer Research Center, and colleagues, an ASCO clinical practice guideline update panel made no changes to the 2014 recommendations for sentinel lymph node biopsy in women with early-stage breast cancer.

The update panel searched the literature for randomized controlled trials, systematic reviews, meta-analyses, and clinical practice guidelines reported between 2012 through July 2016. Eight publications were identified and reviewed; the findings reaffirmed the 2014 recommendations, with none of the information prompting changes to the guideline. The update panel was co-chaired by Dr. Lyman and Armando E. Giuliano, MD, of Cedars-Sinai Medical Center, Los Angeles.

Recommendations

The current recommendations are briefly summarized here. The first three are supported by evidence from randomized controlled trials.

  • Women without sentinel lymph node metastases should not receive axillary lymph node dissection.
  • Women with one to two metastatic sentinel lymph nodes who are planning to undergo breast-conserving surgery with whole-breast radiotherapy should not undergo axillary lymph node dissection (in most cases).
  • Women with sentinel lymph node metastases who will undergo mastectomy should be offered axillary lymph node dissection.
  • Women with operable breast cancer and multicentric tumors, with ductal carcinoma in situ, who will undergo mastectomy, who previously underwent breast and/or axillary surgery, or who received preoperative/neoadjuvant systemic therapy may be offered sentinel node biopsy.
  • Women who have large or locally advanced invasive breast cancer (tumor size T3/T4), inflammatory breast cancer, or ductal carcinoma in situ (when breast-conserving surgery is planned) or are pregnant should not undergo sentinel node biopsy.

Mark R. Somerfield, PhD, of ASCO, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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