Classic and novel approaches to sentinel lymph node detection in patients with invasive breast cancer

Sentinel lymph node biopsy is a revolutionary approach used in a complex management of patients with invasive breast cancer. Only a few decades ago, all patients diagnosed with this condition underwent a radical removal of all axillary lymph nodes to determine the stage of the cancer and to prevent further lymphatic metastasis. This surgery has been associated with numerous side effects, sometimes even more serious than complications after the removal of the primary tumour. The growing understanding of lymph circulation and its drainage patterns led to the concept of sentinel lymph nodes, which in turn led to the development of assorted techniques used for their mapping/detection. This review paper discusses the classic methods of sentinel lymph node detection, their status in clinical practice and novel emerging approaches. The classic is a "gold standard" combination of lymphoscintigraphy and blue dye. Although dominant in practice, it has numerous drawbacks. Novel techniques implement superparamagnetic iron oxide nanoparticles, indocyanine green fluorescence and contrast-enhanced ultrasound. These have a potential to establish a new gold standard, which will meet all the most important criteria in this regard - optimal sensitivity, specificity, economic and technical availability and least burden for a patient (Ref. 60). Text in PDF www.elis.sk