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A recent study by British researchers adds to a growing body of research that removing only a few lymph nodes in breast cancer patients to check if cancer has spread may significantly reduce potential side effects compared to the standard method of removing 10-30 lymph nodes. The procedure, called sentinel lymph node biopsy, is a relatively new method to determine whether breast cancer has spread past the breast. Early research has suggested that sentinel lymph node biopsy may be as effective at detecting the spread of breast cancer as the traditional method. Researchers of the current study found that sentinel lymph node biopsy markedly reduced arm swelling (lymphedema) and numbness in the arm (paraesthesia). When breast cancer is diagnosed, women (and men) must often undergo axillary lymph node dissection (i.e., removal of underarm nodes) to check for the spread of cancer. This process is part of "staging" the cancer. However, the removal of these lymph nodes can lead to lymphedema, a condition of chronic swelling of the arm, in about 10-20% of cases. Sentinel lymph node biopsy is a new diagnostic procedure used to determine whether breast cancer has spread to lymph glands under the arm. A sentinel lymph node biopsy requires the removal of only one to three lymph nodes for close review by a pathologist. If the sentinel nodes do not contain cancer cells, this may eliminate the need to remove additional lymph nodes in the axillary area. To determine whether sentinel lymph node biopsy produces fewer side effects in breast cancer patients compared to standard axillary lymph node dissection, Anand David Purushotham, MD of Addenbrooke's Hospital in the United Kingdom, and colleagues studied 298 women. Half of the women had undergone sentinel lymph node biopsy while half had had axillary lymph node dissection. The study results showed that lymphedema (arm swelling) was 70% lower in the women who underwent sentinel lymph node biopsy, and paraesthesia (a condition of numbness, tingling, prickling or burning in the arm) was 60% lower among these women. In general, quality of life was better for the women who underwent sentinel lymph node biopsy. Professor John Toy, Cancer Research UK's Medical Director, says: "The results of this trial are very promising. They show that sentinel lymph node biopsy can greatly reduce the number of women who experience side effects after surgery for breast cancer. We now need to confirm that testing the sentinel glands is an accurate way of showing that cancer has not spread to glands in the armpit, and thus can be used with complete confidence to help plan appropriate patient management. Although preliminary data from various studies indicate that this is the case, doctors need to 'follow up' women who have taken part in trials for at least five years to be completely certain. Once we have all of this information, surgeons will be able to consider offering sentinel lymph node biopsy as standard treatment." Additional Resources and References The study discussed in this article, "Morbidity After Sentinel Lymph Node Biopsy in Primary Breast Cancer: Results From a Randomized Controlled Trial," appeared in the July 1, 2005 issue of the Journal of Clinical Oncology, http://jco.org/ To learn more about sentinel lymph node biopsy, please visit http://www.imaginis.com/breasthealth/sentinelnode.asp

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