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Sentinel lymph node biopsy in breast cancer: Techniques

Seth P Harlow, MD
Section Editor
Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
Deputy Editor
Wenliang Chen, MD, PhD


According to the sentinel lymph node hypothesis, tumor cells migrating from a primary tumor metastasize to one or a few lymph nodes before involving others. Evidence suggests that the entire breast drains to the same few sentinel lymph nodes regardless of the injection site [1]. These few lymph nodes are called "sentinel" lymph nodes, the status of which would accurately predict the status of the remaining lymph nodes.

Sentinel lymph node biopsy (SLNB) was first introduced as a technique of axillary nodal staging for breast cancer by Giuliano and Krag in 1993 and 1994 [2,3]. It has since become the standard of care for axillary staging in clinically node-negative breast cancer [4]. A properly performed SLNB identifies patients who need further axillary clearance, while sparing others a potentially morbid axillary lymph node dissection (ALND) [5].

The techniques of SLNB in breast cancer will be reviewed here. The indications, contraindications, and outcomes of SLNB as well as the management of patients after an SLNB are discussed separately. (See "Overview of sentinel lymph node biopsy in breast cancer" and "Management of the regional lymph nodes in breast cancer".)


Proper surgical technique in SLNB minimizes the risk of understaging and undertreating patients, which in turn influences outcomes.

SLNB typically begins with injection of one or two tracers into breast skin or parenchyma either in the vicinity of the tumor or under the areolar plexus. These tracers enter lymphatic channels and passively flow to the draining lymph nodes. Sentinel lymph nodes are then identified as those first receiving drainage from the tumor by the presence of tracer and removed. Although sentinel nodes draining the breast can be variably located, they are usually found within the lower axilla (level I) [6].

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Literature review current through: Nov 2017. | This topic last updated: Jul 27, 2017.
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