How Should We View the Results of the Multicenter Selective Lymphadenectomy Trial-1 (MSLT-1)?

Abstract

Prior to the release of the initial findings of the Multicenter Selective Lymphadenectomy Trial-1 (MSLT-1), SLN biopsy had already been generally embraced by the worldwide surgical community as a valuable staging tool and as a minimally invasive way to accurately identify patients with clinically occult regional lymph node metastases. The application of regional lymph node dissection only for patients with positive SLNs–termed “selective lymphadenectomy”–effectively minimizes the development of clinical nodal disease and spares node-negative patients the morbidity of a formal lymph node dissection. This management strategy has been promoted as a rational alternative to the two prior popularized approaches of elective lymph node dissection (ELND) or nodal observation. At the same time, a relatively vocal minority argued that a survival advantage from SLN biopsy should be demonstrated before the routine use of this procedure was endorsed.