The importance of sentinel node biopsy in breast surgery

Summary   Background: In breast cancer patients the axillary nodes play an important role because of their predictive potential. But the merits of routine diagnostic axillary dissection have increasingly been questioned in the past few years on account of the resultant postoperative morbidity. Rediscovered and reinstated in the early 1980s, sentinel node biopsy (SNB) raised new hopes for differential staging with minimal morbidity. Methods: Based on a review of the available literature, the current role of sentinel node biopsy and its future perspectives are discussed and critically evaluated. Results: Sentinel node biopsy proved to be a practicable procedure for precise nodal staging in breast cancer patients associated with low postoperative morbidity. Serial sections of the sentinel node and immunohistochemical assays provide detailed information on lymphatic drainage and more precise staging information. As a by-product, sentinel node biopsy has re-opened the debate about the importance of micrometastases. Clearly defined criteria for patient selection, interdisciplinary cooperation, careful documentation and follow-up are the keys to its success. Conclusions: Like breast-salvaging surgery, sentinel node biopsy appears to mark a major advance in the management of breast cancer patients. More insights into the significance of micrometastases and the role of axillary dissection as well as into the usefulness of SNB post-preoperative chemotherapy and in multicentric lesions can be expected.