Management of the axilla is evolving secondary to accumulating evidence in favor of a more conservative surgical approach. In women who have early-stage breast cancer and limited metastatic disease to SLNs, recent studies suggest that there is no significant survival benefit to completion ALND. Moreover, axillary radiation may be used in place of dissection for local control. As a result, the rate of ALND and, in turn, intraoperative assessment of SLNs has precipitously declined.
For pathologists, the goal of SLN evaluation is to identify macrometastatic disease. There is no need to routinely perform several H&E levels, keratin IHC, or molecular assays to detect small occult metastases. The information provided from such an effort will have little impact on patient treatment and prognosis.
The trials reviewed herein are not without limitations, and future trials are likely needed to further clarify management of the SLN-positive patient. Moreover, the results of ongoing trials are anticipated to offer guidance in how best to approach the care of populations not yet addressed, such as the increasing group of patients with breast cancer who are receiving neoadjuvant therapy for their disease.
Am J Clin Pathol. 2018;150(1):4-17. © 2018 American Society for Clinical Pathology