Evidence map›Paper›PMID 41329312›Full record

ArticleAnnals of surgical oncology2026

Sentinel Lymph Node Biopsy for Prophylactic Mastectomy: Necessary Precaution or Unnecessary Procedure?

Tyler P Shern, Logan R Holt, Victoria Chamberlain, Michele A Gadd, Rebecca M Kwait, Francys C Verdial, Michelle C Specht, Barbara L Smith, Tolga Ozmen

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Article in Annals of surgical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

9 authors.

Tyler P ShernBreast Section, Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, MGH Center for Breast Cancer, Boston, MA, USA.
Logan R HoltBreast Section, Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, MGH Center for Breast Cancer, Boston, MA, USA.
Victoria ChamberlainBreast Section, Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, MGH Center for Breast Cancer, Boston, MA, USA.
Michele A GaddBreast Section, Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, MGH Center for Breast Cancer, Boston, MA, USA.
Rebecca M KwaitBreast Section, Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, MGH Center for Breast Cancer, Boston, MA, USA.
Francys C VerdialBreast Section, Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, MGH Center for Breast Cancer, Boston, MA, USA.
Michelle C SpechtBreast Section, Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, MGH Center for Breast Cancer, Boston, MA, USA.
Barbara L SmithBreast Section, Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, MGH Center for Breast Cancer, Boston, MA, USA.
Tolga OzmenBreast Section, Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, MGH Center for Breast Cancer, Boston, MA, USA. tozmen@mgh.harvard.edu.ORCID http://orcid.org/0000-0002-7136-6195

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe role of sentinel lymph node biopsy (SLNB) in prophylactic mastectomy remains controversial. We aimed to evaluate the diagnostic yield of SLNB and the incidence of occult malignancy in prophylactic nipple-sparing mastectomies (NSMs).

methodsWe performed a review of a prospectively maintained NSM database at Massachusetts General Hospital (2007-2019). Patients undergoing bilateral prophylactic mastectomy (BPM) or contralateral prophylactic mastectomy (CPM) were included. Clinicopathologic features, BRCA status, magnetic resonance imaging findings, and SLNB results were analyzed.

resultsA total of 1624 prophylactic NSMs were performed in 1331 patients (36.1% BPM, 63.9% CPM). SLNB was performed in 53.4% of cases; three patients (0.4%) had positive nodes (two isolated tumor cells in the CPM cohort, one micrometastasis in the BPM cohort), and no macrometastatic disease was identified. Occult cancer was found in 91 cases (5.6%), more frequently in CPMs than in BPMs (6.9 vs. 3.2%, p=0.002). Most occult cancers were in situ (71.4%), and, among invasive cancers, 88.5% were luminal A subtype with a median size of 0.6 cm. Prior ipsilateral radiation and contralateral breast cancer also increased risk. On multivariable analysis, BRCA1/2 positivity was independently associated with a decreased risk of occult cancer (odds ratio 0.47; 95% confidence interval 0.23-0.92; p=0.034). Among patients with occult cancer who underwent preoperative magnetic resonance imaging, 55.3% had false-negative findings.

conclusionsOccult malignancy was uncommon, and SLNB positivity was exceedingly rare in prophylactic NSMs. Routine SLNB is not justified in this setting and should be reserved for select higher-risk scenarios. Personalized, risk-adapted approaches to axillary management and preoperative imaging are warranted.

Indexed as

Breast NeoplasmsCarcinoma, Ductal, BreastProphylactic MastectomySentinel Lymph Node BiopsyUnnecessary ProceduresAdultAgedFemaleFollow-Up StudiesHumansMiddle AgedPrognosisProspective StudiesRetrospective StudiesBRCABreast cancerBreast cancer risk reductionMRINipple-sparing mastectomyProphylactic mastectomySentinel lymph node biopsy

Identifiers

PMID41329312

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.