Sentinel Lymph Node Biopsy versus Axillary Lymph Node Dissection in Early-Stage, Clinically Node-Negative Breast Cancer: A Systematic Review

Abstract

Introduction: Sentinel lymph node biopsy (SLNB) was developed as a less morbid alternative to axillary lymph node dissection (ALND) for staging the axilla in breast cancer. This review evaluates the long-term oncologic safety and morbidity of SLNB.

Methods: A systematic search of large-scale RCTs was conducted. We included trials that randomized women with early-stage, clinically node-negative breast cancer to receive either SLNB (with completion ALND for positive nodes) or upfront ALND. Outcomes were axillary recurrence, overall survival, and morbidity (lymphedema, shoulder dysfunction).

Results: The meta-analysis of five major RCTs showed no significant difference in axillary recurrence rates or overall survival between the SLNB and ALND groups after long-term follow-up. However, the incidence of lymphedema and sensory deficits was significantly lower in the SLNB group.

Discussion: SLNB is an oncologically safe procedure for axillary staging. By avoiding a full ALND in the majority of patients who are node-negative, it significantly reduces treatment-related morbidity and improves quality of life.

Conclusion: Sentinel lymph node biopsy is the standard of care for axillary staging in early-stage breast cancer, offering equivalent survival with lower morbidity compared to ALND.