Sentinel Lymph Node Biopsy in Breast Cancer Treatment : Technical Aspects

In Québec, about 6000 women will be diagnosed in 2009 with breast cancer, which is the most frequent cancer site amongst women. Currently, with population screening mammography and improved imaging techniques, breast cancer is diagnosed at earlier stages and with a lower risk of lymph node invasion, the most significant prognostic factor in early-stage breast cancer. Therefore, patients are more often eligible to less invasive surgeries. Among those surgical techniques, there is sentinel lymph node biopsy or sentinel node biopsy. In some breast cancer cases, it can replace axillary dissection, a traditionally used technique that involves the removing of 15 or so lymph nodes from the axilla for anatomical pathology examination. This technique is associated with non-negligible postoperative morbidity, however. Using sentinel node biopsy would in consequence compromise less the quality of life of those affected by breast cancer.

In this context and according to the high incidence of breast cancer, the Comité de l’évolution des pratiques en oncologie (CEPO) chose to address this issue in order to provide a better framework for medical practices in Québec in this field. The CEPO therefore asked AETMIS to conduct a systematic review of the validity of current evidence on the technical aspects of sentinel node biopsy in breast cancer treatment with a view to providing appropriate guidance on this medical procedure in Québec.

In the light of available data, AETMIS considers that sentinel node biopsy is a proven technique in terms of feasibility and diagnostic accuracy. In experienced hands, it generally yields high identification rates and has a low risk of false negatives (1 - negative predictive value). Certain technical aspects nevertheless influence these performance measures, and are addressed in the report.