![]() It has been suggested that in such cases, the path of the dye or the radio-colloid agent may be blocked from tumor cells infiltrating the lymph vessels. According to the American Society of Clinical Oncology Guideline Recommendations for Sentinel Lymph Node Biopsy in 2005 and the 2001 Proceedings of the Consensus Conference on the Role of SLNB in Carcinoma of the Breast in Philadelphia, patients with clinically positive axilla (N1) are not candidates for the procedure. When there is clinically suspicious axillary lymphadenopathy or when fine needle aspiration cytology and/or core biopsy of palpable axillary lymph nodes confirm tumor infiltration, the procedure is contraindicated. The absolute contraindications for the SLNB are quite clear and straightforward. We review the literature in respect to each and every one of those factors and discuss the impact they may have on the degree of accuracy and efficacy of the procedure. ![]() Certain authors suggest that when present, these factors may affect negatively the accuracy of the SLNB, resulting in failure of the procedure or higher than acceptable false negative results. Furthermore, safety issues like radiation levels to patient (especially during pregnancy) and medical stuff as well as storage and disposal of radioactive waste, still remain debatable issues. These contraindications include host factors such as disturbed lymphatics due to prior breast and axillary biopsy and/or surgery, age, body-mass index, pregnancy, and tumor biologic characteristics such as tumor size, multifocal or multicentric disease and histological type (in situ carcinomas). To ensure and maintain the high accuracy and low false-negative rate of the SLNB procedure, several selection criteria and relative contraindications for the procedure have been reported, together with few safety issues. When performed by an experienced multi-disciplinary team, the SLNB is a highly effective and accurate alternative to standard level I and II axillary clearance. Sentinel lymph node biopsy (SLNB) has become a widely accepted evaluation and staging procedure for the axilla in patients with breast cancer, and this is mainly due to the minimal morbidity and the high degree of histological accuracy it provides. The pathologic status of the axillary lymph nodes remains the most important prognostic indicator for patients with breast cancer and a major determinant of adjuvant treatment.
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