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Guidelines & Advice
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Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer

ID: 17-5 Jul 2016
Type of Content: Guidelines & Advice, Clinical
Document Status: Archived
Authors:
R. George, M. L. Quan, D. McCready, R. McLeod, R.B. Rumble, SLNB in Breast Cancer Expert Panel

Patient Population

Male and female patients with early-stage breast cancer.

Intended Guideline Users

Clinicians involved in breast surgery, including surgeons, pathologists, medical oncologists, radiation oncologists, nuclear medicine practitioners, radiologists, other allied health professionals (e.g., nurses, physiotherapists), administrators, and also breast cancer patients.

Research Question(s)

Clinical Practice

  1. Should SLNB be the recommended standard of care for women and men with proven breast cancer, whose clinical presentation is suggestive of early-stage disease?
  2. How should the results of SLNB be utilized in clinical practice?
    1. Can level I/II axillary lymph node dissection (ALND) be avoided in patients with negative findings on sentinel lymph node biopsy (SLNB)?
    2. Is level I/II ALND necessary for all patients with positive findings on SLNB?
  3. What is the role of SLNB in special circumstances in clinical practice? (special circumstances include large and locally advanced invasive tumours, multicentric tumours, inflammatory breast cancer, ductal carcinoma in situ (DCIS), older age (65 years or more), obesity, male breast cancer, pregnancy, evaluation of the internal mammary nodes, presence of suspicious palpable axillary nodes, prior breast or axillary surgery, and preoperative systemic therapy).
  4. What factors affect the success of SLNB (including low rates of complications and falsenegative results)?
  5. What are the potential benefits and harms associated with SLNB?

Technical Aspects of SLNB

  1. What is the recommended mapping technique for SLNB?
  2. What operative technique is recommended?
  3. What is the recommended technique for pathological processing, handling, and reporting?

Organization of Care

  1. How should the delivery of SLNB be organized in Ontario with respect to team membership, experience and training, and the institutional setting?
    1. What is the recommended experience and training for surgeons who perform SLNB?
    2. What are the recommended criteria and resources for institutions performing SLNB?
pdf download Full Report (PDF) (2.51 MB)

Guideline-Based Clinical Tools

Guidance to Implementing Breast Sentinel Lymph Node Biopsy (SLNB) within a Hospital: An Information Package - Toolkit