Abstract:

Sentinel lymph node biopsy (SLNB) is a surgical technique for diagnosing and treating purposes in breast cancer, which is one of the major advances with milestone significance in the field of breast surgery. As a less-invasive axillary surgery, the development of SLNB has shown a de-escalating trend in the recent 40 years, depending on the greatly improved efficacy of multidiscipline treatment in breast cancer, which indirectly reflects the essence that breast cancer is a systemic disease. First, a series of clinical trials such as Milan SLNB185 and NSABP-B32 confirmed that SLNB is an accurate axillary staging procedure for patients with clinically node-negative early breast cancer. Next, results from ACOSOG Z0011 and IBCSG 23-01 trials further enriched the concept of de-escalating axillary surgery in the sentinel lymph node (SLN)-positive patients and showed that routine axillary lymph node dissection (ALND) can be safely replaced by SLNB in patients with limited tumor burden present with SLN. Furthermore, SLNB and deriving clipped lymph node biopsy extend the target population of minimally invasive axillary surgery to the patients undergoing neoadjuvant therapy. In the recent few years, numerous retrospective studies represented by EUBREAST-061 study and a limited number of prospective studies have preliminarily confirmed the oncological safety of de-escalating axillary surgery in the setting of neoadjuvant therapy. In the future, related research will focus on finding suitable candidates for omitting SLNB including a selected group of low-risk early breast cancer or exceptional responders in neoadjuvant therapy, and the long-term follow-up data of relevant high-quality clinical trials such as SOUND and BOOG 2013-08 are yet to be mature. This article summarized the development history, research progress and future outlook of SLNB, in order to provide a reference for clinicians.

Key words: Breast cancer, Sentinel lymph node biopsy