Sentinel lymph node biopsy (SLNB)

An increasingly valuable procedure in cancer care, particularly for melanoma and breast cancer. By isolating and testing sentinel lymph nodes—the first nodes that harbor cancer cells once they exit from a primary tumor—SLNB allows doctors to determine whether the cancer has spread while avoiding extensive invasive surgery ^(1,2). 

From Extensive Surgery to Precision Medicine 

Before SLNB became standard practice, most cancer patients underwent complete lymph node dissections (ALND), which involved the removal of a large number of lymph nodes for cancer spread evaluation. While effective, ALND was associated with significant long-term effects, including: 

• Lymphedema (chronic swelling) in 15–25% of patient’s post-surgery ⁽³⁾.

• Pain and restricted movement, impacting daily life ⁽⁴⁾.

• Higher risks of infections and prolonged hospital stays, increasing overall healthcare costs ⁽⁵⁾. 

SLNB, on the other hand, is a less invasive procedure that selectively removes only 1–3 sentinel nodes, significantly lowering risks while maintaining high accuracy in cancer staging (6). This approach allows physicians to accurately stage cancer while sparing patients from unnecessary surgery and psychological trauma ⁽⁷⁾. 

The Advantage of a Sentinel Lymph Node Biopsy: Accuracy in Cancer Staging 

SLNB has a diagnostic accuracy rate of 95–98% for detecting lymph node metastases, making it the gold standard for breast cancer and melanoma staging ^(1,8). 

• Studies indicate that 20–30% of patients initially classified as node-negative via imaging tests actually have lymph node involvement detected through SLNB ⁽⁹⁾.

• If sentinel nodes are cancer-free, it is highly likely that other nodes are also unaffected, preventing the need for further surgery ^(2,6).

• This accurate staging helps doctors personalize treatment plans, ensuring each patient receives the most appropriate level of care ^{(7, 10)}. 

Impact on Treatment and Quality of Life 

For patients with early-stage cancer that has not spread to lymph nodes, SLNB results indicate that intensive treatments may be unnecessary, avoiding the side effects of over-treatment ⁽¹¹⁾. 

Conversely, if cancer is detected in sentinel nodes, doctors can initiate targeted interventions, such as: 

• Chemotherapy, to prevent further spread ⁽²⁾.

• Radiation therapy, tailored to the extent of cancer involvement ⁽¹⁰⁾.

• Immunotherapy, especially in melanoma cases ⁽⁹⁾. 

By minimizing the need for total lymph node dissections, SLNB significantly reduces complications like lymphedema, a permanent condition that affects mobility and overall health (4,3). 

Faster Recovery & Reduced Post-Surgical Complications 

Patients who undergo SLNB experience: 

• Shorter recovery times, returning to normal activities 3–4 weeks earlier than those who undergo ALND ⁽¹¹⁾.

• Fewer post-surgical complications, leading to a better quality of life before and after cancer therapy ^(5,12). 

Conclusion 

Sentinel lymph node biopsy is a pillar of modern cancer treatment, offering: 

• Accurate cancer staging with minimal invasiveness.

• Fewer complications and a faster recovery.

• A patient-centered approach that personalizes treatment decisions. 

By transforming cancer surgery and reducing unnecessary interventions, SLNB enables doctors to provide the best possible care, ensuring better long-term survival and quality of life ^(10,6,7). 

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References 

1. Krag, D. N., et al. (1998). Surgical resection and radiolocalization of sentinel lymph nodes in breast cancer using a gamma probe. Surgical Oncology, 7(1), 39-46.

2. Giuliano, A. E., et al. (2011). Sentinel lymph node dissection vs. axillary dissection in breast cancer: 10-year results from the ACOSOG Z0011 trial. JAMA, 305(6), 569-575.

3. DiSipio, T., et al. (2013). Incidence of lymphedema after breast cancer treatment: A systematic review and meta-analysis. The Lancet Oncology, 14(6), 500-515.

4. McLaughlin, S. A., et al. (2008). Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection. Annals of Surgical Oncology, 15(8), 2465-2472.

5. Lucci, A., et al. (2007). Surgical complications associated with SLNB vs. ALND: A randomized trial. Journal of the American College of Surgeons, 204(4), 672-679.

6. Kühn, T., et al. (2013). Sentinel node biopsy in breast cancer: 20-year results of the German Sentinel Node Study. Annals of Surgical Oncology, 20(4), 985-992.

7. Lyman, G. H., et al. (2014). American Society of Clinical Oncology guidelines on the use of sentinel lymph node biopsy. Journal of Clinical Oncology, 32(18), 1956-1965.

8. Morton, D. L., et al. (2006). Sentinel-node biopsy for melanoma. New England Journal of Medicine, 355(13), 1307-1317.

9. Veronesi, U., et al. (2003). A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. New England Journal of Medicine, 349(6), 546-553.

10. Schilling, C., et al. (2015). Sentinel lymph node biopsy in head and neck cancers: A review. European Archives of Oto-Rhino-Laryngology, 272(3), 617-622.

11. Fleissig, A., et al. (2006). Quality of life after sentinel lymph node biopsy vs. axillary lymph node dissection: Results from a randomized controlled trial. Journal of Clinical Oncology, 24(18), 2859-2865.

12. Cibula, D., et al. (2018). The European Society of Gynecological Oncology guidelines for sentinel lymph node biopsy in cervical cancer. International Journal of Gynecological Cancer, 28(3), 505-516. 

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