Status of lymph node staging.

Sentinel node biopsy has the potential to provide more accurate staging information than axillary node dissection. Given the considerable morbidity of axillary node dissection this less invasive approach is attractive. However, there are a number of issues to be resolved before the best technique of sentinel node biopsy is determined. When large studies with long-term follow up demonstrate that lymphatic mapping to identify clinically occult lymph node metastases is as effective as we hope, then full axillary node dissection can be reserved to treat patients who indeed have lymph node metastases. Around 60% of the patients could then be spared an axillary node dissection that they do not need because they do not have metastases there. Modern technology is providing more accurate prognostic information based on primary tumor characteristics. Applying these technologies to sentinel lymph nodes may render the lymph node status even more relevant than it currently is.