WHO IS NOT A CANDIDATE FOR SLND?
Several circumstances disqualify patients for SLND and make traditional ALND a better choice. Patients who have obviously INVOLVED lymph nodes should have a complete axillary nodal dissection because its always a good policy to remove any cancer accessible to the surgeons. Ive had problems accurately mapping the axilla in patients who have had large biopsies or “lumpectomies”. Something about the surgical procedure itself disturbs the lymphatic circulation and interrupts the flow from the breast into the underarm and makes the precise identification of the “sentinel” node impossible. The LOCATION of the primary cancer may (inner aspect of breast or axillary tumor) interfere with nuclear isotope labeling or indicate a sentinel node in an inaccessible position like the intra-thoracic internal mammary nodes. Finally patients with LARGE tumors (>5 cm) should consider having chemotherapy first prior to any definitive treatment of the breast or the axilla because the disease is presumed to b
