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Sentinel-Node Biopsy vs. Axillary Dissection in Breast Cancer

Sentinel-node biopsy is associated with fewer arm complications than is standard axillary dissection.

The sentinel lymph node, the first node to receive drainage from a tumor, can be identified by injecting a dye or radioactive tracer near the tumor. In breast cancer patients with clinically negative axillary nodes, sentinel-node biopsy is an alternative to routine axillary-node dissection. Because most patients in whom sentinel-node biopsies are negative do not have axillary metastases, they can forgo axillary dissection and avoid its potential complications (e.g., lymphedema, pain, limited shoulder movement).

In this study from the U.K., 1031 patients with clinically node-negative invasive breast cancer were randomized to undergo either standard axillary dissection or sentinel-node biopsy. About 25% of biopsy patients had sentinel-node metastases, and most of them proceeded to axillary dissection. In intent-to-treat analyses, biopsy patients were significantly less likely than standard-treatment patients to report lymphedema (5% vs. 13%) and sensory deficits (11% vs. 31%) at 12 months. Quality-of-life scores were modestly, but significantly, higher in the biopsy group.

Comment: These findings confirm that sentinel-node biopsy is associated with fewer arm complications than is standard axillary dissection. The American Society of Clinical Oncology considers sentinel-node biopsy to be "an appropriate initial alternative to routine staging axillary lymph node dissection" in breast cancer patients with clinically negative axillary nodes (J Clin Oncol 2005; 23:7703). However, long-term follow-up from this and several other ongoing trials is needed to show that the sentinel-node strategy does not compromise survival.

— Allan S. Brett, MD

Published in Journal Watch General Medicine May 23, 2006

Citation(s):

Mansel RE et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: The ALMANAC trial. J Natl Cancer Inst 2006 May 3; 98:599-609.

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