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May 8, 2025, 15:13

Sanjit Agrawal: Sentinel Lymph Node Biopsy in LMICS

Sanjit Agrawal, Breast surgeon at Tata Cancer hospital, posted on LinkedIn:

“Sentinel Lymph Node Biopsy (SLNB) in LMICS – Challenges and Solutions.

My primary research interest is improving access to and quality of Sentinel Lymph Node Biopsy (SLNB) for eligible breast cancer patients in low- and middle-income countries (LMICS). Over the past 10 years, I have led and co-authored six key publications addressing the unique challenges and solutions surrounding SLNB in these settings. This research has addressed critical knowledge and practice gaps and has influenced policy and surgical protocols in LMICS. The following research questions were explored through prospective studies, practice surveys, and large cohort analyses:

Key Research Contributions:

Quality Indicators of SLNB: Defined benchmarks for SLNB performance in non-screened breast cancer populations typical of LMICS
Barriers to SLNB Adoption: Conducted a national survey of Indian surgeons to identify key barriers preventing using SLNB in eligible breast cancer patients.
SLNB Feasibility Post-Lumpectomy
Designed and implemented a prospective interventional study evaluating SLNB in patients diagnosed after prior lumpectomy—an LMIC-specific challenge.
ICG vs. Radioisotope Tracers: Demonstrated the clinical feasibility of Indocyanine Green (ICG) as a cost-effective, non-radioactive alternative to traditional SLNB tracers.
Applicability of the Z0011 Trial: Evaluated the relevance of the Z0011 trial findings in unscreened breast cancer cohorts in LMICs, contributing to tailored axillary management strategies.
SLNB Outcomes in 1,500 Patients: Reported one of the largest Southeast Asian cohorts, analysing oncological safety and outcomes of SLNB in 1,500 breast cancer patients.

These studies form the backbone of an ongoing effort to de-escalate axillary surgery, improve resource utilisation, and expand evidence-based surgical oncology in under-resourced healthcare settings. I sincerely thank ecancer, the Indian Journal of Surgical Oncology, and ASCO Journals for providing platforms to disseminate our research through open-access publications. Their APC waiver support has been instrumental in ensuring that critical work on breast cancer surgery and SLNB in LMICs remains accessible to a global audience—particularly in resource-constrained settings where such evidence is most needed.”

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