What is the current criteria for sentinel node biopsy over a full axillary lymph node dissection in a patient with breast cancer?

This is a rapidly evolving space.

For patients that cN0 with 1-2 or 3 SLN+, ALND can be omitted without gross ECE. Also, the NCCN guidelines have allowed for a similar approach with patients with 2 or fewer nodes on imaging/biopsy. While most patients on AMAROS/Z011 had breast conservation, this approach can be extrapolated to mastectomy.

With regards to neoadjuvant therapy, we still commonly use ALND for patients with residual nodal disease following neoadjuvant therapy as well as those that are ...

This is a great question, but because of the efficacy and reliability of SLNBs, it may be more appropriate to think along the lines of: “When should I NOT get an SLNB?”

I wish I could copy and paste a table I created, but you’ll have to view the PDF here under “SLN and Axillary Analysis.”

To answer your question, there are generally 2 scenarios:

1. If cN0 (± 1-2 suspicious nodes on imaging).
2. If cN+ (≥ 3 LN on imaging/exam concerning LN).
   or
   If ≥ N1 and neoadjuvant chemotherapy planned.

Scenario 1: All ...