Should I skip sentinel lymph node biopsy under new guidelines?

This is such a thoughtful question to bring to the community, and it's great that both your surgeon and radiation oncologist are supportive of either path. The decision between sentinel lymph node biopsy and full breast radiation involves weighing different benefits and risks that are unique to each person's situation. Hearing from others who have navigated similar choices in this HR+ HER2- community could provide valuable insights as you work with your medical team to determine what feels right for your specific circumstances.

Hmm, I had Stage 1a breast cancer in 2020 and I wasn't given the choice. My doctor said sentinel lymph node out of the gate and full breast radiation. When I asked why full breast radiation for a 8mm tumor with no lymph node involvement. Her answer was thats just what we do. This is a major cancer hospital as well.

The guidelines changed in 2025 following the SOUND and INSEMa trials

It depends on the size of your tumor. I had a NEG sentinel node bx with a lumpectomy & I need a whole breast radiation bc of the size of my tumor (3.4 cm)

I am also considering NO radiation. There are 2 trials(CALGB 4393 & PRIME ll) that showed women who are equal or greater than 65 yrs old have the same remission rates as those who were treated with radiation.

Yes I am aware. My tumor size is 7-9mm. If you don’t do sentinel node biopsy then you need to do whole breast radiation. They still don’t want to double stack de-escalation. I did read about those trials but I am 63. I am scheduled for surgery on Wednesday and have decided to go ahead with sentinel node biopsy and am hopeful that nothing much will change on final pathology so I can do targeted short course radiation and then hormone therapy. There are also studies on reducing the dose of hormones. This whole field is changing rapidly and de-escalation is what they are working towards.

I had Sentinel lymph node biopsy. 4 yrs ago I had lumpectomy for 1 cm tumor. I WAS 73 yrs old. They found that one of 2 nodes tested had cancer. The nodes were encapsulated which meant no evidence of further spread. I received full breast radiation of rt. Breast and nodes under my arm were also radiated. Yesterday I had my Mammogram. It was negative for cancer for 4th year. Thank God. I take anestrozole daily for past 4 years. It will be your decision but I wanted to know if there was metastasis. Good luck to you.

Decided to go ahead and have the sentinel node biopsy. 4 nodes were taken all negative and no lvi. Very grateful!!

That's great news! Congratulations!

I have stage 2b hormone sensitive with node involvement. I had a lumpectomy and sentinel node removal 3/17/26. Started anastrozole a few weeks later and am now receiving low dose radiation with a boost at the end. I don’t regret removal of the node at all. I have no lymphedema from that area. I have 3 aunts who died from bc and 3 cousins who have it- all different types. So I am going to get out anything that is suspect. I’d rather trust the science, live and do everything I can to reduce the chances of recurrence.