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| |  Sentinel Node Biopsy Preferred in New Breast Cancer Guidelines: Presented at NCCN By Ed Susman HOLLYWOOD, Fla -- March 13, 2010 -- Sentinel node biopsy in women undergoing breast cancer surgery has been elevated as the preferred practice -- when performed by an experienced team, researchers said here at the 15th Annual National Comprehensive Cancer Network (NCCN) Conference on Clinical Practice Guidelines and Quality Cancer Care. In fact, the NCCN guidelines, which were outlined here on March 11, have removed axillary dissection from the treatment algorithm for women who do not have clinical signs of axillary involvement, said Robert Carlson, MD, Stanford University, Stanford, California. “The only time we would recommend axillary dissection would be in cases in which clinicians were able to palpate masses in the axillary regions that were suspicious of cancer,” Dr. Carlson said. He said axillary dissection would be performed if the sentinel node biopsy proved positive for cancer or if other tests indicated the cancer had spread to the axillary lymph nodes. Dr. Carlson said that the NCCN’s committee decision to suggest starting with sentinel lymph node biopsy in breast cancer for a number of reasons: in experienced hands, the sentinel node can be identified in >95% of cases; the false-negative rate with sentinel lymph node is <10%; breast cancer recurrence in the axillary nodes is <1% if the sentinel lymph node is negative; the occurrence of lymphoedema is ~7%; and sentinel lymph node biopsy procedures are performed widely in the United States. Dr. Carlson said that giving sentinel lymph node prominence -- and removing axillary dissection from the guidelines -- acknowledges that the sentinel node procedure is functionally already the standard in the United States. The change also promotes referral to centres with skilled sentinel node teams. Dr. Carlson noted that there are arguments against promoting sentinel node biopsy, including the recognition that access to skilled providers of sentinel node biopsy may be limited in certain areas of the country. Noting that the NCCN guidelines are used worldwide, he said that the guideline might not be generalised to other countries. The guidelines now suggest that staging for clinical stage I/II patients should undergo sentinel node biopsy with “an experienced sentinel node team.” If a team is not available, the patient should be referred to an experienced team. If the sentinel node is positive, axillary dissection is indicated. [Presentation title: NCCN Breast Cancer Guidelines Update]
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