Recent Advances and Concepts in SLNB (Sentinel Lymph Node Biopsy) and Management of SLNB Positive Axilla in Carcinoma Breast

Breast cancer is one of the three most common cancers occurring worldwide. In 2018, one in four newly detected cancer in women was breast cancer in India. Breast cancer treatment approaches have changed from “maximum tolerable” to “minimum effective” with the same cure rates and cosmesis but better quality of life (QoL). However, the management of the axilla has been a debatable topic since many decades. For the proper management of breast cancer, it is essential to differentiate clinically node-positive or clinically node-negative patients but having a positive sentinel lymph node (SLN). Axillary staging is one of the most important prognostic variables in breast cancer treatment. Sentinel lymph node biopsy (SLNB) may spare many patients the need for axillary lymph node dissection (ALND) as well as the morbidities associated with ALND. In this review, we have discussed the observations from various trials and guidelines recommendations on the need or omission of ALND in patients with breast cancer undergoing SLNB. The various tracer used for identification of SLN and the best combination available for staging the axilla with high accuracy and low risk of false negativity has been assessed. The timing and accuracy of SLNB in patients who are receiving neoadjuvant chemotherapy (NACT) for breast cancer have also been discussed. The impact of ALND on locoregional recurrence (LR), overall survival (OS), and disease-free survival (DFS) outcomes in SLNs positive patients has been evaluated. We have proposed a treatment algorithm to follow, in addition to the local/regional guideline recommendations, before planning the treatment strategy for breast cancer patients.