Sentinel Node Biopsy (SNB) in ۲۰۱۴

American Society for Clinical Oncology(ASCO) published in its May ۲۰۱۴ issue,recommendations about the sentinel node biopsy(SNB) practice. The importance of this society for ۱the physicians and surgeons practicing in the field ofbreast cancer and the well-known expertscontributed to develop these recommendations hasmade them a milestone in our practice, even thoughthey are not applicable to all of our patients.These recommendations are based on threeprospective randomized trials: NSABP B۳۲,ACOSOG Z۰۰۱۱ and IBCSG ۲۳-۰۱ in which thepatients were supposed to receive a breastconservative therapy (BCT) followed by radiationtherapy and a medical treatment, chemo and/ orhormonal therapy.۲-۴These trials had several points to be discussed;the main one being the absence of information on thetangential fields of radiation therapy directedtowards the axillary fossa. The second point isvariation in follow-up durations in mentioned trials.While, NSABP follow-up ismore than ۱۰ years, thetwo others have a much shorter follow-up (۴-۵years). Additionally, there are some methodologicalconcerns e.g. inclusion rate inferior to the initiallyexpected leading to the early termination of the trialand enrolling patients who underwent mastectomiesin the Italian trial. The last but not the least, there is aconcern about the follow-up at ten years in theseearly breast cancers since events can occur after tenyears of follow up mainly in hormone receptorpositive tumors.