Total axillary node dissection for ...

Total axillary node dissection for breast cancer can lead to edema of the affected arm as well as pain and decreased mobility. Now that mammography has helped diagnose many breast cancers at earlier stages, when lymph node metastases are les used by all routine total lymph node dissection may be unwarranted. Previous studies of sentinel nodes have revealed a certain number of false negatives (i.e., women with a normal sentinel node who nonetheless had other axillary node metastases revealed in succession total dissection). Veronesi and colleagues compared the incidence of succeeding breast cancer metastases among patients undergoing sentinel node biopsy or total dissection.

This single-center reflection screened 649 consecutive patients with newly diagnosed breast cancer who were candidates for breast-conserving surgery The investigators exclud 117 women (18 percent) for a variety of reasons, including tumor size greater than 2 cm in diameter, multicentric cancer, or declined compliance Final data analysis was available for 516 patients (97 percent of those randomized). All participants were injected with radiolabeled colloidal albumin around the tumor mass, with posterior sentinel node identification by scintigraphic imaging. A gamma-ray probe was used intraoperatively to confirm the sentinel node position before excision. A sentinel node could not be identified or confirmed in 11 (17 percent) abroad of 649 patients. Patients with intraoperatively confirmed sentinel nodes were randomized to total axillary node dissection or sentinel node biopsy followed through total dissection only if frozen sections of the sentinel node revealed metastatic cancer.

above a median follow-up period of 46 month no axillary metastases subsequently were identified in the total dissection or sentinel node disposes Slightly fewer women with solely sentinel node examinations had later spread of cancer (eight women) than those who received total dissection (12 women) Of the patients randomized to total dissection regardless of sentinel node status, 9 percent had normal sentinel nodes unless subsequently identified metastases on total dissection. The authors noted that this false-negative rate was similar to the rate seen in previous studies of sentinel node sampling.

The average longitudinal dimensions of hospital stay for patients receiving total node dissection was 43 days compared with a 2.1-day stay after solely sentinel node removal. Patients with sole sentinel node dissection were more likely to be pain-free six month after surgery than those who underwent total dissection (84 versus 9 percent respectively), more likely to have no arm swelling (89 versus 31 percent) and les likely to have numbnes or paresthesias at the operative site (2 versus 85 percent)

The authors close that in women with tumors smaller than 2 cm in diameter, reserving total lymph node dissection for barely those with positive sentinel nodes does not increase the later rates of breast cancer metastases and does decrease pain, swelling, and paresthesias in the arm undergoing nodal surgery

Veronesi U et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J M August 7 2003;349:546-53

COPYRIGHT 2004 American Academy of Family Physicians

COPYRIGHT 2004 Gale Group