Sentinel Lymph Node Biopsy Guidelines

Disease-Specific Requirements

The National Comprehensive Cancer Network recommends that sentinel nodes should be evaluated with serial sectioning and immunohistochemistry for melanoma patients 1
For oral/oropharyngeal squamous cell carcinoma, at least the 3 nodes with the highest radioactivity should be excised, with all positive sentinel nodes detected within the first 5 nodes of highest activity 2, 3
Three-quarters of oral/oropharyngeal squamous cell carcinoma patients have 3 or fewer sentinel nodes 2, 3

After sentinel node excision, verify completeness by measuring residual radioactivity in the lymphatic basin, with a count rate less than one-tenth that of the excised node with the lowest radioactivity indicating all sentinel nodes have been identified and removed 2, 3

The American Society of Clinical Oncology recommends that each sentinel node should be submitted in a separate cassette to permit accurate assessment 5
For breast cancer after neoadjuvant chemotherapy, false-negative rates are 31% if only one sentinel node is removed and 12% when two nodes are removed, according to the Journal of Clinical Oncology 6, 7, 8
The SENTINA trial observed false-negative rates of 14.2%, with much higher rates when only one or two nodes were removed for breast cancer after neoadjuvant chemotherapy 6, 7, 8