Is sentinel node biopsy necessary in the radiologically negative axilla in breast cancer?

Felix Jozsa*, Muneer Ahmed, Rose Baker, Michael Douek

*Corresponding author for this work

Research output: Contribution to journalEditorialpeer-review

23 Citations (Scopus)


Purpose: The steady move towards axillary conservatism in breast cancer is based on studies demonstrating that axillary node clearance affords no survival benefit in a subset of patients with a positive pre-operative axillary ultrasound (AUS). However, less attention has been paid to AUS-negative patients who receive sentinel node biopsy as standard. Methods: Previously assembled systematic review data was reassessed to evaluate nodal burden amongst patients with breast cancer and a clinically and radiologically negative axilla. Results: Pooled data from four cohort studies reporting pre-operative axillary ultrasound in 5139 patients with breast cancer show it has a negative predictive rate of 0.951 (95% confidence interval 0.941–0.960). Conclusions: Reconsidering the use of ultrasound in patients with early breast cancer and non-palpable axillae reveals that sentinel node biopsy itself may represent surgical over-treatment in patients with a negative axillary ultrasound. The implications of this on the future of surgical management of the axilla are discussed.

Original languageEnglish
JournalBreast Cancer Research and Treatment
Issue number1
Early online date31 May 2019
Publication statusPublished - 30 Aug 2019


  • Axillary conservatism
  • Axillary node clearance
  • Axillary node metastasis
  • Axillary ultrasound
  • Sentinel node biopsy


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