Section 3
Sentinel Node Biopsy: Implications to Medical Oncologists

SELECTION OF PATIENTS

Sentinel node biopsy is appropriate for the overwhelming majority of patients. Sometimes there are technical limitations — for example when the cancer is in the axilla — not an infrequent site of breast cancer. Obviously, the closer the cancer is to the axillary nodes, the harder the mapping. We also have to be cautious when there are multiple invasive cancers in the breast, because even though it appears that the breast drains to common nodes, that still is an unknown question. We also have to be cautious with stage III breast cancers. Lymph nodes replaced with tumor may not have lymphatic flow, and there also is the issue of the effects of inflammatory carcinoma on the skin. But outside of those rare exceptions, sentinel node biopsy is absolutely an appropriate treatment.There has been some concern that the sentinel node in a patient who’s already had a breast biopsy is not accurate.That’s absolutely not true. It works just as well whether the tumor is in the breast or not.

—Patrick Borgen, MD

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IMPLICATIONS OF ENHANCED PATHOLOGY

A key issue for medical oncologists is interpretation of enhanced pathology on a single sentinel node as opposed to pathology on 20 axillary lymph nodes. The greatest challenge is the sentinel lymph node with one IHC-positive cell in the subcapsular sinus. Is that metastatic breast cancer? Is it clinically relevant, and should it be treated as N1 disease? Should more surgery be undertaken? Another critical issue is integrating sentinel node mapping into the growing field of neoadjuvant chemotherapy. Should patients have sentinel node mapping before or after chemotherapy? Should it be trusted after chemotherapy? Sentinel node mapping is an exploding area right now, and medical oncologists need to be really keyed into it.

—Patrick Borgen, MD

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