Scientists say that removing fewer lymph nodes in surgery for breast cancer patients causes less harm and often demonstrates equally good results. This is according to a review published in JAMA.
Researchers from the University of Texas Southwestern Medical Center conducted a review of the risks and benefits of sentinel lymph node biopsy (SLNB), compared with complete axillary lymph node dissection (ALND) from 17 previous studies published in JAMA.
The procedures were also compared with women who underwent nonsurgical treatments, such as additional radiation, who did not have palpable lymph nodes or evidence from ultrasounds that the cancer had spread to their axillary nodes.
SLNB involves less extensive surgery and the removal of fewer lymph nodes. The sentinel lymph node is usually the first lymph node to which cancer cells from a primary tumor will spread.
When a woman receives a positive sentinel lymph node biopsy, this indicates the tumor has spread, and this is used to determine what stage the cancer is at.
Axillary lymph nodes are found at the edge of the chest muscles, the armpits and lower neck. ALND involves the removal of all 20-30 lymph nodes.
The review showed that breast-conserving therapy – partial mastectomy followed by whole breast radiation – alongside a complete ALND for women with no suspicious axillary nodes, is associated with more harm than benefit, compared with SLNB alone.
The researchers note there were also no significant benefits for breast-conserving therapy alongside complete ALND for patients who had tumors 3 cm or smaller, or who had fewer than three positive lymph nodes in their sentinel lymph nodes biopsy.
“In the past, axillary nodal status was a critical factor considered in therapy decisions,” says Dr. Roshni Rao, associate professor of surgery at the University of Texas and study author.
“With the validation of sentinel lymph node biopsy, the same staging information can be obtained with less morbidity and risk to the patient.
And now that decisions regarding chemotherapy are often guided by molecular tumor profiling in an era of personalized medicine, there are other avenues to explore beyond aggressive surgeries.”
Dr. Rao stresses that it is important for women to avoid axillary surgery if possible, as the procedure can cause various shoulder and arm symptoms. These include severe pain or numbness and reduced range of motion.
Furthermore, she says that the ALND procedure results in longer hospital stays, compared with the SLND surgery.
Medical News Today recently reported on a study that identified ten critical gaps in breast cancer research that need to be addressed in order to save hundreds and thousands of lives.