Should we examine sentinel lymph nodes during the operation?

Axillary lymph node metastasis is one of the most important predictor of outcome in breast cancer (1,2). Currently sentinel lymph node biopsy (SLNBx) has been established as the golden standard to determine the node status (3). The concept of analyzing the first “gate keeper lymph node” to define the likelihood of further lymphatic spread has dramatically transformed the surgical approach against breast cancer. It is very well known that the routine axillary lymph node dissection (ALND) is associated with high complication rate, and the practice of selective SLNBx has significantly reduced its occurrence (4,5).