Which of the following is a recognised contraindication to sentinel lymph node biopsy in breast cancer?

• A A 12 mm ER-positive tumour in a 70-year-old woman
• B Clinically and radiologically normal axilla with dual tracer mapping
• C Palpable, matted axillary nodes on examination ✓
• D Previous wide local excision in the same breast with intact axilla

Explanation

Palpable or imaging-suspicious axillary nodal disease is a contraindication to sentinel node biopsy because tracer bypasses involved nodes, producing a falsely negative map; these patients need axillary dissection or nodal sampling. Small tumour size, older age and previous breast-conserving surgery with an untouched axilla are all accepted indications, and dual localisation with blue dye plus radioactive colloid improves identification rates. Prior axillary surgery or irradiation, and inflammatory carcinoma, are the other standard exclusions.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.