Are Sentinel Lymph Node Mapping and Resection Applicable to Chinese Breast Cancer Patients?

Abstract

Traditional standard breast cancer surgery is composed of total mastectomy and axillary lymph node dissection (ALND). Three decades ago, total mastectomy was challenged by Veronesi, with the proposal that partial mastectomy with radiotherapy to the remaining breast tissue produces a similar outcome to total mastectomy in early breast cancer.1 ALND is still a standard surgical procedure in the treatment of breast cancer, with or without axillary lymph node (ALN) metastasis. Nonetheless, complications from ALND are still problematic. Other methods have failed to surpass ALND. 2 Cabanas proposed the “sentinel lymph node” (SLN) concept in 1977 and applied this to breast cancer patients, thus allowing patients with negative axillary nodes to be spared from ALND.3 The basis of the SLN concept is that the cancer metastasizes first to one node before spreading to the other nodes. This first node is called the SLN; if the SLN is free of cancer, one can assume that the rest of the lymph nodes are also cancer-free. Therefore, lymph node dissection and its related complications can be avoided. The impression from numerous ongoing clinical trials4–7 is that ALND is not required for breast cancer patients with a negative SLN. The incidence of breast cancer among Chinese women is increasing,8 as is the number of patients with clinically impalpable axillary lymph nodes. Is this new trend suitable for Chinese breast cancer patients? A summary of SLN findings on Chinese breast cancer patients and those of European and American patients is presented in this issue.