The trials reporting on survival are not large enough to detect survival benefits. Longer follow-up and pooled analysis are needed.
Of the six randomised trials4-12 comparing sentinel node biopsy to axillary dissection (Table 1) all were well designed and well conducted. However, the following should be noted:
- only one trial9 is large enough in size to be able to detect a survival benefit
- overall and disease-free survival were reported by smaller trials or those with short-term follow-up
- morbidity and quality of life were measured differently between the trials.
Of the six randomised trials13-18 investigating technique for sentinel node biopsy, those reporting detection agents were small trials,13,15 those reporting injection sites16,17 used different sites across the trials, and only one trial18 reported on treatment following a positive sentinel node, while two more trials29,30 investigating this topic are ongoing.
Clinical practice recommendations developed by NBOCC* will be reviewed and revised as required as additional significant evidence becomes available.
* In February 2008, National Breast Cancer Centre (NBCC), incorporating the Ovarian Cancer Program, changed its name to National Breast and Ovarian Cancer Centre (NBOCC). In July 2011, NBOCC amalgamated with Cancer Australia to form a single national agency, Cancer Australia, to provide leadership in cancer control and improve outcomes for Australians affected by cancer.