Lymphatic mapping with sentinel lymph node biopsy for breast cancer

Institute for Clinical Systems Improvement
Record ID 32003000561
English
Authors' objectives:

This review aims to assess the available evidence on the effectiveness of lymphatic mapping with sentinel lymph node biopsy for breast cancer.

Authors' recommendations: With regard to lymphatic mapping with sentinel lymph node biopsy (SLNB), the ICSI Technology Assessment Committee finds the following: For axillary staging, SLNB has become an acceptable alternative to axillary lymph node dissection (LND) in patients with invasive breast cancer. (Conclusion Grade II) SLNB would be appropriate for patients with solitary tumors less than 5 cm and a clinically negative axilla. SLNB should be performed by an experienced surgeon. The literature would suggest that to achieve an acceptable identification rate (>=85%) and false negative rate (<=5%), at least 10 to 20 cases of SLNB followed by LND should be performed. At present, no long term survival data are available. Two national, multicenter, randomized trials designed to evaluate survival are underway. The procedure is safe; reports of procedure-related complications are rare, adverse effects are minimal, and exposure levels to radioactive materials (when used) have been found to be acceptable. There is a learning curve for locating the sentinel node(s) (SN). A protocol that uses both vital blue dye and a radioactive tracer is typically easier to learn and results in lower false negative rates. The approach requires a multidisciplinary team including surgeons, radiologists (nuclear radiologists if radioactive materials are to be used), pathologists, and medical or radiation oncologists and, if radioactive materials are used, must be done in facilities adequately equipped to dispose of those materials. It appears that serial sectioning with immunohistochemical (IHC) staining detects more occult nodal metastases. Clinical trials are underway to determine the significance of IHC positive cells in lymph nodes.
Authors' methods: Review
Details
Project Status: Completed
URL for project: http://www.icsi.org/index.asp
Year Published: 2002
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: United States
MeSH Terms
  • Lymph Nodes
  • Lymphatic Metastasis
  • Sentinel Lymph Node Biopsy
  • Breast Neoplasms
Contact
Organisation Name: Institute for Clinical Systems Improvement
Contact Address: 8009 34th Avenue South, Suite 1200, Bloomington, MN, USA. Tel: +1 952 814 7060; Fax: +1 952 858 9675
Contact Name: icsi.info@icsi.org
Contact Email: icsi.info@icsi.org
Copyright: Institute for Clinical Systems Improvement (ICSI)
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.