According to the results of a clinical trial published in the Journal of the National Cancer Institute, breast cancer patients who undergo sentinel lymph node biopsy experience fewer arm problems and report better quality of life than patients who undergo traditional axillary lymph node dissection.
For over 30 years, the standard for early breast cancer staging has included the removal of approximately 10 to 25 axillary (under the arm) lymph nodes to help determine whether the cancer has spread. This procedure, called an axillary lymph node dissection (ALND), can be associated with chronic side effects, including pain, limited shoulder motion, numbness, and swelling.
A more recent approach to evaluate whether cancer has spread to the lymph nodes is sentinel lymph node biopsy. The advantage of this procedure is that only a small number of sentinel nodes (or even a single node) are removed. Sentinel nodes are the first lymph nodes to which cancer is likely to spread.
Sentinel lymph node biopsy is becoming more widely adopted in the clinical setting for determining whether cancer has spread to the lymph nodes in women with localized breast cancer. There is some evidence that the procedure improves quality of life compared to ALND, but few clinical trials have addressed this question.
To determine whether sentinel lymph node biopsy results in better quality of life than ALND, researchers conducted a clinical trial among 1031 patients with early breast cancer. Half the women were randomly assigned to undergo sentinel lymph node biopsy and half were randomly assigned to undergo ALND.
- At 12 months after surgery, lymphedema (swelling of the arm) was reported by 5% of women who underwent sentinel lymph node biopsy and 13% of women who underwent ALND.
- At 12 months after surgery, arm numbness was reported by 11% of women who underwent sentinel lymph node biopsy and 31% of women who underwent ALND.
- Patient-reported quality of life and arm functioning was significantly better in women who underwent sentinel lymph node biopsy.
The researchers conclude that sentinel lymph node biopsy is linked with fewer arm problems and better quality of life than axillary lymph node dissection. The researchers note that sentinel lymph node biopsy “should be the treatment of choice for patients who have early-stage breast cancer with clinically negative nodes.”
Reference: Mansel RE, Fallowfield L, Kissin M et al. Randomized Multicenter Trial of Sentinel Node Biopsy Versus Standard Axillary Treatment in Operable Breast Cancer: The ALMANAC Trial. Journal of the National Cancer Institute. 2006;98:599-609.
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