Sentinel node biopsy for personalized breast cancer management; advances and controversies

Sentinel lymph node biopsy (SLNB) has become the gold standard for axillary lymph node staging, providing valuable prognostic information while minimizing complications compared to axillary lymph node dissection. However, there are ongoing debates and controversies surrounding SLNB in specific cases. Studies have explored the use of SLNB in neoadjuvant chemotherapy, emphasizing the need for customized therapy decisions. Factors such as age, tumor characteristics, and treatment response influence the selection of SLNB or axillary lymph node dissection. Additionally, the presence of extranodal extension, micrometastases, and isolated tumor cells has been evaluated to determine the need for lymphadenectomy. The importance of accurate oncological staging by thorough pathological evaluation has been highlighted, particularly with regards to invasion depth and lympho-vascular invasion. The significance of biological tumor status, such as hormone receptor and HER2 status, in axillary management decisions has been emphasized. Moreover, discussions have emerged regarding SLNB in the context of local recurrence, with differing perspectives on its utility. Future extensive studies are needed to refine protocols and incorporate these concepts related to SLNB into breast cancer management guidelines.