From the Research
The recommended number of lymph nodes to remove during sentinel lymph node biopsy (SLNB) for breast cancer is at least 2 nodes, as this has been shown to decrease the false-negative rate and improve recurrence-free survival, as demonstrated in a study published in the American Journal of Surgery in 2017 1.
Key Considerations
- The goal of SLNB is to balance thorough staging with minimizing surgical morbidity.
- The sentinel nodes are the first lymph nodes to receive lymphatic drainage from the breast tumor and are identified during surgery using blue dye, radioactive tracers, or both.
- Removing more than 5 nodes generally does not improve diagnostic accuracy and may increase the risk of complications such as lymphedema, seroma formation, and nerve injury, as shown in a study published in Lymphatic Research and Biology in 2022 2.
Evidence-Based Recommendations
- A study published in the American Journal of Surgery in 2017 found that patients with only 1 total harvested lymph node (THLN) showed lower recurrence-free survival (RFS) as compared to those with ≥2 THLNs (p = 0.049) 1.
- Another study published in Lymphatic Research and Biology in 2022 found that patients who had >5 lymph nodes excised had a higher incidence of lymphedema (3.7% vs 1.4%, p = 0.006) 2.
Clinical Implications
- The specific number of lymph nodes to remove may vary based on individual patient factors, tumor characteristics, and institutional protocols.
- Surgeons should carefully search for additional nodes to ensure accurate staging if fewer than 2 nodes are identified.
- The false-negative rate of SLNB decreases significantly when at least 2-3 nodes are removed, dropping from approximately 10-15% with a single node to 5-7% with multiple nodes.