New ASCO guidelines on sentinel lymph node biopsy (SLNB)
The American Society of Clinical Oncology has updated its guidelines on sentinel lymph node biopsy (SLNB) for early-stage breast cancer.
SLNB can now be omitted in some patients with stage I or II disease. The update applies to postmenopausal women aged 50 and older with hormone receptor–positive, HER2-negative tumors no larger than 2 cm. Preoperative axillary ultrasound must show no signs of cancer.
The goal is to reduce unnecessary surgery, complications like lymphedema, and healthcare costs. SLNB has been linked to long-term arm pain and reduced motion.
The recommendations follow a review of recent trials, including SOUND and INSEMA. In most cases, when axillary ultrasound is clear, SLNB also shows no cancer.
The new guidance supports less aggressive surgery. It also emphasizes careful planning between surgeons and radiation specialists, as treatment decisions are closely linked.
