Sentinel lymph node (SLN) biopsy, which is associated with fewer complications than axillary lymph node dissection (ALND), may be safe and effective for most patients who do not have axillary mode metastases. Furthermore, some SLN-biopsy positive patients can omit ALND at the physician’s discretion, according to an article published in the November issue of the British Journal of Surgery.
Although surgical techniques for early-stage breast cancer have become less extensive, ALND has remained the standard course for women with node-positive disease. However, ALND is associated with a 20 percent lymphedema rate. In addition, increasing node negativity rates and the lack of a survival advantage with ALND have led to increasing use of SLN biopsy, wrote J.R. Benson and G.C. Wishart, from Cambridge Breast Unit at Cambridge University Hospital NHS Foundation Trust in Cambridge, England.
The authors noted that axillary ultrasound with core biopsy of selected nodes can deselect patients for SLN biopsy, explaining that SLN is effective for the more than half of patients with single node involvement.
Benson and Wishart suggested that clinicians bypass ALND in older women with smaller non-high-grade tumors and micrometastasis confined to a single node, adding that results of the American College of Surgeons Oncology Group Z0011 trial may open the door to an expansion of this group. Potentially eligible candidates include women with T1 or T2 tumors with macrometastases and micrometastases in one or two sentinel nodes.
The authors noted a low statistical probability of clinically significant non-SLN tumor foci in women with micrometastases. A more stringent policy for omission on ALND could reduce the chance of non-SLN involvement, Benson and Wishart wrote. They concluded by emphasizing the importance of auditing patient outcomes as new policies are developed.