Sentinel signal detection.

There’s a lot of nuance when it comes to breast cancer surgery in 2022, but data suggests there really should be only one tried and true recommendation for inflammatory breast cancer: modified radical mastectomy. And, yes, that includes a full axillary lymph node dissection regardless of clinical nodal presentation or response to neoadjuvant therapy. Beyond conferring at least double the mortality rate of other breast cancers, the inflammatory variety classically alters subdermal lymphatics leading to a very unsatisfying false-negative rate of roughly 25% with standard sentinel node sampling techniques. It’s disconcerting, then, that this NCDB analysis of nearly 1100 women undergoing surgery for inflammatory breast cancer reveals the use of sentinel node sampling in this population is not only consequential but has doubled between 2012 (11%) to 2017 (22%). In other words, there’s been “a non-data-driven frequent and increasing use of sentinel node biopsy in patients with inflammatory breast cancer.” | Sosa, JAMA Netw Open 2022