 
New Procedure for Early Breast Cancer Reduces Complications |
Most often, an axillary lymph node dissection (ALND) is performed on a woman with early breast cancer to uncover whether or not the cancer has metastasized. Metastasis is the most significant predictor of survival and indicates whether a women needs post-surgical hormonal treatment or chemotherapy.
ALND involves removing most of the axillary lymph nodes. Although ALND accurately reveals the stage of illness and decreases the risk of tumor occurrence under the arm, it requires hospitalization and may result in severe complications. In addition, about only one-third of women with early breast cancer will have lymph node metastasis.
Women who undergo axillary lymph node dissection have a 10 to 20 percent chance of developing severe arm swelling. This often requires extended physical rehabilitation as well as significant discomfort. In addition, after ALND, most women experience lifelong upper arm numbness, occasional shoulder dysfunction and, sometimes, chronic pain.
Comparatively, the sentinel lymph node biopsy is less invasive. The sentinel lymph node is defined as the lymph node most likely to harbor tumor metastasis, if the tumor has spread from the primary tumor. The sentinel lymph node procedure involves injecting substances around the tumor that are taken up by the lymphatic channels that then migrate to the first lymph node or lymph nodes. These tracers are deposited into the sentinel node and help to identify it so the surgeon may remove it for examination.
"This examination is far less extensive than is normally performed for axillary lymph node dissection," said Pond R. Kelemen, M.D., professor of surgery at the School of Medicine. "Usually, the morning before the surgery, a radioactive isotope is injected around the tumor, and nuclear scan pictures are taken of its migration to the axillary nodes. At the time of surgery, after the patient receives general anesthesia, a blue dye is injected around the tumor, which then is allowed to migrate to the lymph node. It is excised approximately five to 10 minutes after. The sentinel node is then examined extensively with routine and special stains to look for any evidence of metastasis."
In the one-third of cases where the identified sentinel lymph node contains a metastasis, it is recommended that the ALND be performed so as to control disease under the arm and provide an accurate diagnosis for treatment. But patients found to have no tumor in their sentinel node are not required to have the axillary dissection, avoiding the complications associated with ALND.
"This is becoming a very popular procedure," Kelemen said. "In addition, we are participating in a trial that would eliminate, by one-half, the number of patients who would normally undergo axillary lymph node dissection for a sentinel node with tumor metastasis."
For more information about the sentinel lymph node procedure or the clinical trial, please call SLUCare at 268-5880.
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