Sentinel lymph node biopsy in low risk settings

Am J Surg. 2017 Sep;214(3):489-494. doi: 10.1016/j.amjsurg.2017.03.006. Epub 2017 Mar 15.


Background: Sentinel lymph node biopsy (SLNB) should be performed in patients with ductal carcinoma in situ (DCIS) undergoing mastectomy. Yet, the same logic is controversial in the setting of prophylactic mastectomy.

Methods: Surgeons were surveyed as to their practices. Statistical analyses were performed to identify associated factors.

Results: 238 surgeons responded to the survey. 73.1% of respondents stated they would always perform SLNB in the setting of mastectomy for DCIS, but only 6.6% would always do so in the prophylactic setting. While generally perceived that the rate of SLN positivity in the setting of pure DCIS and prophylactic mastectomy was <5% (96.9% and 99.5%, respectively), 61.8% of surgeons who reported "always" performing SLNB in the setting of DCIS treated with mastectomy stated they "never" performed a SLNB for prophylactic mastectomy.

Conclusion: SLNB practice patterns for these low risk settings are disparate. Consensus is required to rationalize practice.

Keywords: DCIS; Low risk; Mastectomy; Prophylactic mastectomy; SLNB.

MeSH terms

  • Adult
  • Aged
  • Breast Neoplasms / pathology*
  • Breast Neoplasms / surgery*
  • Carcinoma, Intraductal, Noninfiltrating / pathology*
  • Carcinoma, Intraductal, Noninfiltrating / surgery*
  • Female
  • Health Care Surveys
  • Humans
  • Mastectomy*
  • Middle Aged
  • Practice Patterns, Physicians'*
  • Risk Assessment
  • Sentinel Lymph Node Biopsy
  • Surgical Oncology*