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. 2024 Feb;19(1):18-26.
doi: 10.1159/000533731. Epub 2023 Sep 16.

Strict versus Liberal Use of Sentinel Node Biopsy in Breast Cancer Surgery: Any Clinical Outcome Differences? A 20-Year Clinical Experience

Israel Barco  1 , Marc García-Font  2 , Antonio García-Fdez  1 , Manel Fraile  3 , Elena Vallejo  1 , MCarmen Vidal  4 , Sonia González  1 , Clarisa González  5 , Claudia Beatriz Mitru  6 , Oriol Porta  1 , Carolina Chabrera Sanz  7
Affiliations

Strict versus Liberal Use of Sentinel Node Biopsy in Breast Cancer Surgery: Any Clinical Outcome Differences? A 20-Year Clinical Experience

Israel Barco et al. Breast Care (Basel). 2024 Feb.

Abstract

Introduction: As applied to early breast cancer (BC) patients, sentinel node biopsy (SNB) has undergone major changes over the years, especially concerning the widening of indication criteria or skipping systematic axillary lymph node dissection (ALND) after a positive SN. We aimed to ascertain whether a strict versus a more liberal use of SNB resulted in different clinical outcomes in our clinical experience.

Methods: We studied consecutive BC patients undergoing SNB between January 1, 2000, and March 31, 2020. There were 1,587 patients and 1,634 SNB procedures. Cases were divided into two study groups: the "strict" SNB group (unifocal tumors up to 35 mm in which ALND was always performed for a positive SN, amounting to 1,183 SNBs), and the "liberal" SNB group (extended tumor size up to selected T3 cases, as well as multifocal or bilateral disease, and patients with previous contralateral BC, not always followed by ALND after a positive SN, amounting to 451 SNBs). Patients were closely followed up to the end of the study.

Results: Clinico-pathological variables were strikingly different between study groups, with the liberal group showing a higher risk profile. Cox regression analysis for disease recurrence did not show significant differences in axillary, lymph node, or locoregional recurrence rates or distant relapse. There were no differences in survival between groups.

Conclusion: It seems reasonable to adopt the liberal SNB approach, as the goal of surgical management in early BC patients must be attaining optimal locoregional disease control, no matter the differences in distant metastatic spread rates across different BC risk profiles.

Keywords: Axillary recurrence; Breast cancer; Sentinel node biopsy; Survival.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1.
Fig. 1.
Time spread of “strict” versus “liberal” SNB procedures over the 20-year period of our SNB practice.
Fig. 2.
Fig. 2.
a Axillary lymph node relapse. b Lymph node relapse. c Lymph node metastases. d Overall metastases.
See this image and copyright information in PMC

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