American Society of Clinical Oncology Guideline Recommendations for Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer

ASCO SIGN IN

Manage Email Subscriptions

Username:

Create an account

Why Be A Member?

Password:

Remember me

Forgot your username or password?

ASCO Membership Directory

The Remember Me feature is an automatic login process which creates a cookie on the hard drive of your computer containing a unique identifier which ASCO.org will utilize to remember you by, thereby avoiding the need to enter username and password upon subsequent visits to ASCO.org. DO NOT select this option if you share this computer with others since transactional, personal, or member only information will be accessible by other users.

To activate the Remember Me option, click the empty check box when signing in to the site. The Remember Me functionality is deactivated at the logout.

For additional information please review our Privacy Policy.

ASCO Home

Practice & Guidelines

Guidelines

Clinical Practice Guidelines

American Society of Clinical Oncology Guideline Recommendations for Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer

Published in Journal of Clinical Oncology, Vol 23, No 30 (October 20), 2005: pp. 7703-7720

Gary H. Lyman, Armando E. Giuliano, Mark R. Somerfield, Al B. Benson III, Diane C. Bodurka, Harold J. Burstein, Alistair J. Cochran, Hiram S. Cody III, Stephen B. Edge, Sharon Galper, James A. Hayman, Theodore Y. Kim, Cheryl L. Perkins, Donald A. Podoloff, Visa Haran Sivasubramaniam, Roderick R. Turner, Richard Wahl, Donald L. Weaver, Antonio C. Wolff, and Eric P. Winer

Objective: To develop a guideline for the use of sentinel node biopsy (SNB) in early stage breast cancer.

Method: An American Society of Clinical Oncology (ASCO) Expert Panel conducted a systematic review of the literature available through February 2004 on the use of SNB in early stage breast cancer. The panel developed a guideline for clinicians and patients regarding the appropriate use of a sentinel lymph node identification and sampling procedure from hereon referred to as SNB. The guideline was reviewed by selected experts in the field and the ASCO Health Services Committee and was approved by the ASCO Board of Directors.

Results: The literature review identified one published prospective randomized controlled trial in which SNB was compared with axillary lymph node dissection (ALND), four limited meta-analyses, and 69 published single-institution and multicenter trials in which the test performance of SNB was evaluated with respect to the results of ALND (completion axillary dissection). There are currently no data on the effect of SLN biopsy on long-term survival of patients with breast cancer. However, a review of the available evidence demonstrates that, when performed by experienced clinicians, SNB appears to be a safe and acceptably accurate method for identifying early stage breast cancer without involvement of the axillary lymph nodes.

Recommendations: SNB is an appropriate initial alternative to routine staging ALND for patients with early stage breast cancer with clinically negative axillary nodes. Completion ALND remains standard treatment for patients with axillary metastases identified on SNB. Appropriately identified patients with negative results of SNB, when done under the direction of an experienced surgeon, need not have completion ALND. Isolated cancer cells detected by pathologic examination of the SLN with use of specialized techniques are currently of unknown clinical significance. Although such specialized techniques are often used, they are not a required part of SLN evaluation for breast cancer at this time. Data suggest that SNB is associated with less morbidity than ALND, but the comparative effects of these two approaches on tumor recurrence or patient survival are unknown.

ASCO’s practice guidelines reflect expert consensus based on clinical evidence and literature available at the time they are written and are intended to assist physicians in clinical decision-making and identify questions and settings for further research. Due to the rapid flow of scientific information in oncology, new evidence may have emerged since the time a guideline was submitted for publication. Guidelines are not continually updated and may not reflect the most recent evidence. Guidelines address only the topics specifically identified in the guideline and are not applicable to interventions, diseases or stages of disease not specifically identified. Guidelines cannot account for individual variation among patients and cannot be considered inclusive of all proper methods of care or exclusive of other treatments. It is the responsibility of the treating physician or other health care provider, relying on independent experience and knowledge of the patient, to determine the best course of treatment for the patient. Accordingly, adherence to any guideline is voluntary, with the ultimate determination regarding its application to be made by the physician in light of each patient's individual circumstances and preferences. ASCO guidelines describe the use of procedures and therapies in clinical practice and cannot be assumed to apply to the use of these interventions in the context of clinical trials. ASCO assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of ASCO's guidelines, or for any errors or omissions.