(HealthDay News) — The American Society of Clinical Oncology has updated its clinical practice guideline on the use of sentinel node biopsy (SNB) in early breast cancer. The updated guideline was published online March 24 in the Journal of Clinical Oncology.

Gary H. Lyman, M.D., M.P.H., of the University of Washington in Seattle, and colleagues updated the recommendations for the use of SNB in patients with early-stage breast cancer based on nine randomized clinical trials and 13 cohort studies.

The researchers found that, based on evidence from randomized, controlled trials, women with early breast cancer who do not have sentinel lymph node (SLN) metastases should not receive axillary lymph node dissection (ALND). In most cases, women with one to two metastatic SLNs who are planning to undergo breast-conserving surgery with whole-breast radiotherapy should not undergo ALND. Women with SLN metastases who will receive a mastectomy should be offered ALND. Insufficient data were available to make any changes to the 2005 recommendations, based on weaker evidence, that women with early breast cancer who should not undergo SNB include those with large or locally advanced invasive breast cancer (tumor size T3/T4), inflammatory breast cancer, ductal carcinoma in situ with planned breast-conserving surgery, or pregnant women.

“The most critical determinant of breast cancer prognosis is still the presence and extent of lymph node involvement,” Lyman said in a statement.

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