Sentinel lymph node biopsy in breast cancer: scientific rationale and patient care.

PURPOSE/OBJECTIVES: To describe the history of sentinel lymph node biopsy (SLNB), review the current scientific literature comparing the benefits and shortcomings of SLNB with traditional axillary lymph node dissection, and describe the nursing role that should be employed when instructing patients who are considering SLNB.

DATA SOURCES

Journal articles, published research data, and clinical experience.

DATA SYNTHESIS

Traditional axillary lymph node dissection has the potential to cause serious complications such as lymphedema, scarring, numbness, pain, and psychological distress. Given that approximately 70% of women with early-stage breast cancer will have no evidence of regional lymph node involvement at the time of surgery, determining who is likely to have negative nodes will spare women these potential complications. SLNB can significantly minimize the morbidity associated with axillary lymph node dissection while providing accurate diagnostic and prognostic information.

CONCLUSION

SLNB has been well documented in the scientific literature from multiple phase III clinical trials as an accurate, safe, and fiscally conservative alternative to traditional axillary lymph node dissection for women who present with early-stage breast cancer. Furthermore, future results from multicenter, randomized clinical trials now under way ultimately will determine the role for SLNB in the years to come.

IMPLICATIONS FOR NURSING PRACTICE

Nurses in the outpatient setting can help to minimize the anxiety and fear that patients have when they are considering SLNB versus the more traditional axillary lymph node dissection. Oncology nurses also serve as resources to other nurses, healthcare professionals, and the public as more information is learned concerning the role of SLNB in early-stage breast cancer.