While patients with invasive breast cancer no longer undergo automatic mastectomy, routine removal of lymph nodes in the armpit region (standard axillary dissection) is still commonly carried out in order to find and take out lymph nodes with cancer in them. However, lymph node removal can cause a number of unpleasant side effects, such as decreased arm and shoulder function. For women with early-stage breast cancer, this type of surgery has little benefit, and some scientists suggest doctors could evaluate breast cancer using a less invasive technique called sentinel lymph node biopsy, where the first lymph node to which fluid from a primary breast tumor drains, is removed and examined.
Robert E. Mansel, of the Wales College of Medicine at Cardiff University in the United Kingdom, and colleagues examined data from 1031 breast cancer patients in the randomized ALMANAC trial, half of whom received sentinel lymph node biopsy followed by lymph node removal, the other half of whom underwent lymph node removal. Data on patients was collected between November 1999 and October 2003.
The authors found that sentinel lymph node biopsy was associated with better arm function, better quality of life, a shorter hospital stay, and faster recommencement of daily activities than standard axillary lymph node dissection. In addition, women who underwent a sentinel lymph node biopsy had a low recurrence rate of cancer and had survival rates equivalent to those of women in the standard treatment group.
The authors write, "This study has shown that sentinel lymph node biopsy is a safe and effective alternative to routine axillary dissection for [lymph node evaluation] in early-stage breast cancer. […] Our results support the introduction of this minimally invasive staging procedure in operable breast cancer."
In an accompanying editorial, Joseph L. Pater, M.D., and Wendy Parulekar, M.D., of Queen's University in Kingston, Ontario, discuss the strengths and limitations of Mansel and colleagues' study. They question whether the widespread adoption of sentinel lymph node biopsy will need to change once long-term outcome data on relapse-free and overall survival are published. They write, "Given all the information provided, it seems likely that Mansel et al. are correct in concluding that patients obtain benefit from avoiding axillary dissection. However, results of trials with health-related quality-of-life outcomes cannot always be interpreted unambiguously, and more effort is needed to accomplish the goal of having patient-reported outcomes routinely and reliably incorporated into cancer trials."
Contacts:
Article: Robert Mansel, 44-2920-742749, manselre@cf.ac.uk
Editorial: Nancy Dorrance, 613-533-2869, dorrance@post.queensu.ca
Citations:
Article: Mansel RE, Fallowfield L, Kissin M, Goyal A, Newcombe RG, Dixon JM, et al. Randomized Multicenter Trial of Sentinel Node Biopsy versus Standard Axillary Treatment in Operable Breast Cancer: the ALMANAC Trial. J Natl Cancer Inst 2006; 98:599–609.
Editorial: Pater JL, Parulekar W. Sentinel Lymph Node Biopsy in Early Breast Cancer: Has Its Time Come? J Natl Cancer Inst 2006; 98:568–569.
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JNCI Journal of the National Cancer Institute