American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Standard 2.4: Sentinel Node Biopsy

Axillary sentinel lymph node biopsy is considered or performed for patients with early-stage breast cancer (Clinical Stage I, II).

Definition and Requirements

Patients currently considered candidates for axillary sentinel lymph node biopsy include those with:

  • American Joint Committee on Cancer (AJCC) Stage I, IIA, and IIB invasive breast cancer with no suspicious axillary lymph nodes
  • Resectable, locally advanced, invasive breast cancer, either before or after neoadjuvant systemic therapy
  • Extensive  ductal carcinoma in situ (DCIS) requiring total mastectomy, no suspicious axillary nodes
  • DCIS requiring wide excision in an anatomic location interfering with future, accurate sentinel lymph node mapping, no suspicious axillary nodes
  • Unilateral or bilateral prophylactic mastectomy

Some patients who meet the criteria above may be deemed inappropriate for sentinel node biopsy. An example of such a patient might be an elderly, debilitated patient with a clinically negative axilla.

A patient can decline a sentinel node biopsy. If the patient declines, it should be documented in the patient medical record.

The accuracy of sentinel lymph node biopsy may be compromised in patients who have had previous ipsilateral breast-conserving surgery, axillary surgery, or breast radiation therapy.

Process Requirements

Accession List and Data Review Requirements for the Site Visit

The center is required to provide a de-identified accession (case) list of breast cancer cases diagnosed and/or treated at the center (class of case 10–14) prior to the site visit date. Class of case is defined in the Facility Oncology Registry Data Standards (FORDS) manual.

When sentinel node biopsy is not offered, the medical record should indicate the reason.

Patients can decline sentinel node biopsy. The medical record should indicate that this procedure has been offered.

Compliance is reviewed annually by the Breast Program Leadership Committee (BPLC).


Complete all required standard fields in the Survey Application Record (SAR).

Document the annual audit by the BPLC in the meeting minutes.


The surveyor will review patient medical records during the medical records review portion of the site visit to evaluate compliance with sentinel lymph node biopsy utilization.

Rating Compliance


  1. Axillary sentinel lymph node biopsy is considered or performed for patients with early-stage breast cancer (Clinical Stage I, II).
  2. Compliance is reviewed annually by the BPLC and documented in the meeting minutes.


The center does not fulfill one or more of the compliance criteria.