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CATEGORIES [ TREATMENT, ASCO2011 ]

New information from sentinel lymph node studies in breast cancer

BY DEBU TRIPATHY | JUNE 7, 2010

Over the last decade, the use of sentinel node biopsy has reduced the number of patients who need a full axillary lymph node dissection for treatment and staging of breast cancer.

This represents a very important advance because a sentinel node biopsy is much less likely to lead to long term lymphedema--chronic swelling of the arm that can have a large impact on day-to-day activities and quality of life. However, when one or more sentinel nodes, which are identified by using a blue colored dye and radioactive tracer, are found to contain tumor cells, a full axillary dissection is recommended.

Sentinel node biopsies are done in patients who do not have any nodes felt on physical examination, but about one third of patients who are found to have tumor in the sentinel nodes are currently treated with follow-up complete surgery.

To determine whether additional surgery and its attendant risks are really needed, the American College of Surgeons conducted a trial to see if patients with up to three positive sentinel nodes could be spared a full dissection. This randomized trial compared no further surgery to full dissection in such patients, and the results showed no difference in the number of patients that had a recurrence in the breast or under the arm--about 3 to 4 percent overall, with six years of follow-up.

In the commentary provided on this abstract it was stated that these results are "practice changing" and if adopted, would make a big difference in the side effect profile of breast surgery in the estimated 50,000 of patients who undergo axillary dissection in the United States.

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COMMENTS

I am a 1+ year IDC survivor who opted for breast conservation surgery and sentinel node biopsy. What a relief that this study was done and it is reassuring that the results showed no difference in recurrence rates between the two groups. In my breast cancer support group, there are many women who suffer with lymphedema secondary to their axillary node dissection when a sentinel node biopsy was not common practice. With new pathologic testing, my concern is the middle ground where there is micro metastasis found in the sentinel node. What is the next step in these cases? In cases where there is a small tumor (< 1cm) and clear margins, I question if a full dissection be appropriate since axillary node dissection is done to stage the cancer, not prevent metastasis. It will be interesting to see the results of further studies.
- Posted by Nadean 6/22/10 7:18 AM

I am so happy to read this! Two years ago my sentinel node was found to have a cell of cancer (and maybe more since they don't look at the whole node). I opted to not have any further nodes removed, because, as an artist, I was very afraid of lymphodema and any resulting damage to my arm. It was the one choice I made that made me nervous-but now it looks like I can relax (somewhat)
- Posted by cynthia 7/28/10 3:27 PM

I wasn't given a choice after one of the sentinel nodes was found to have a cell of cancer. So the doctor removed 14 nodes under my right arm. I was asleep & was never asked. So far I haven't had any trouble but I wished I had a choice.
- Posted by Denise Thomas 7/28/10 6:20 PM

My surgeon did a sentinel node biopsy (0/3) and did not proceed to do an axillary node dissection, even though guidelines call for a full axillary node dissection if you have Inflammatory Breast Cancer (IBC). I was not given any choice in the matter. I've had no recurrence since my surgery in the Spring of 2008 and hope to remain NED (no evidence of disease/no expiration date) for many years. If I had been given a choice, I probably would have gone for the full dissection set forth in the guidelines and taken my chances with getting lymphedema.
- Posted by Claudia in FL 7/29/10 9:52 AM

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