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Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer

Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer

In 2005, the American Society of Clinical Oncology (ASCO) first published evidence-based clinical practice guidelines for using sentinel node biopsy (SNB) in patients with early-stage breast cancer. In 2014, these guidelines were updated and published in the Journal of Clinical Oncology. “Since publication of the original guidelines, several new randomized trial results and additional cohort studies have become available,” says Gary H. Lyman, MD, MPH, who co-chaired the ASCO expert panels for both versions of the guidelines. “We now have more evidence from clinical trials supporting the use of SNB as a less invasive cancer-staging technique for a larger group of patients.” Developing the Guidelines To develop the guideline update, ASCO convened experts in medical oncology, pathology, radiation oncology, surgical oncology, guideline implementation, and patient advocacy. A systematic review of the literature published from February 2004 to January 2013 in Medline was conducted. The subsequent recommendations were based on a review of the evidence. The update also includes an appendix on technical issues related to pathology. The ASCO guideline summarizes the updated literature search and analyzes new data related to the recommendations since the last systematic review. The update incorporates new evidence from more recent studies—including nine randomized controlled trials and 13 cohort studies—since 2005. Based on the results of these studies, more patients can now safely undergo SNB without axillary lymph node dissection (ALND). “The guidelines can help clinicians determine for whom SNB is appropriate,” says Dr. Lyman. “This may enable more women with early stage breast cancer to avoid ALND, which is more invasive and is associated with a greater risk of complications.” ALND can cause a...
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