TUESDAY, Feb. 8 (HealthDay News) -- Removing many lymph nodes
may not be necessary in women with early breast cancer who also
undergo a lumpectomy to remove the mass, followed by radiation.
Researchers reporting in the Feb. 9 issue of the
Journal of the American Medical Association found that just
removing one or two sentinel nodes -- those lymph nodes to which
the cancer spreads first -- allows women to live just as long as
women who have more lymph nodes removed from under their arm.
But it's unclear at this point whether this could be
"If you're looking at a woman with a very limited amount of disease in the sentinel node and with a very limited amount of disease undergoing breast conservation surgery [lumpectomy], it may suggest that they can potentially avoid axillary dissection [removing most or all of the lymph nodes under the arm] . . . but that's being said with a lot of caution," noted Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York City, who was not involved with the study. "[But] we can't say that they absolutely can."
Another expert was more emphatic.
"This is an important study," said Dr. Jay Brooks, chairman of hematology and oncology at Ochsner Health System in Baton Rouge, La. "It's the largest randomized trial showing that women with positive sentinel nodes do not necessarily need to have further axillary [underarm] sampling when treated with radiation and/or chemo. This will reduce complications, and will change the way doctors approach patients."
Among other things, removal of lymph nodes can result in a
painful and debilitating condition called lymphedema, or swelling,
because lymph fluids can no longer travel freely through the
The standard of care in breast cancer is still debated but
generally, said Bernik, "If you have a positive lymph node, the
standard generally is to use axillary dissection unless [cancer
involvement] is thought to be minimal in the lymph node."
These researchers, from the John Wayne Cancer Institute at Saint
John's Health Center in Santa Monica, Calif., wanted to see if they
could avoid axillary dissection without compromising survival.
After undergoing lumpectomy to remove the tumor, followed by
radiation and chemotherapy, women with evidence of cancer in one or
two sentinel nodes were randomized to undergo axillary node
dissection of 10 nodes or, alternatively, to forgo any further
The study involved about 1,000 women, only half of the 2,000 the
researchers had set out to enroll.
In those having axillary node dissection, the median number of
nodes removed was 17, vs. two with sentinel only.
But there didn't seem to be any differences with survival, with
more than 92 percent in both groups still alive after five years,
indicating to the authors that sentinel node biopsy might be not
only less invasive, with fewer side effects, but also
But the report is unlikely to quell an ongoing controversy
surrounding lymph node removal, Bernik said. In fact, she noted, it
may even add to it.
The women in the study were not necessarily representative of
all women with breast cancer, and generally had less cancer in
their lymph nodes: Those with cancer that had progressed further
were unlikely to be willing to be randomized into one of the two
groups, she said.
"People have to understand that we're looking not at all women undergoing sentinel node biopsy. We're looking at a select group," Bernik said. "Some people are going to say that based on this data, we can avoid axillary dissection, and I think it's probably too premature to say that."
The U.S. National Cancer Institute has more on
sentinel lymph node biopsy.