Removal of all axillary lymph nodes may be unnecessary in women undergoing breast-conserving therapy (partial mastectomy followed by whole-breast radiation), researchers have found.
Recent data from clinical trials have challenged traditional thinking about axillary surgery in persons with breast cancer, pointed out a team led by Roshni Rao, MD, of the Harold C. Simmons Cancer Center at The University of Texas (UT) Southwestern Medical Center in Dallas, Texas, in JAMA (2013;310:1385-1394). Until recently, clinical practice guidelines advised complete axillary node dissection (removal of all 20 to 30 axillary lymph nodes) to prevent metastasis if the woman’s sentinel node biopsy was positive.
However, a systematic review by Rao and her colleagues indicated that according to available evidence, axillary node dissection is associated with more harm than benefit in women undergoing breast-conserving therapy who meet the following three conditions:
- They do not have palpable, suspicious lymph nodes.
- Their tumor is no larger than 3.0 cm.
- They have no more than three positive nodes on sentinel node biopsy.
The review showed that complete axillary node dissection in patients with no palpable lymph nodes provided no survival benefit compared with sentinel node biopsy and is associated with a 1% to 3% reduction in recurrence of axillary lymph node metastases, but is associated with a 14% risk of lymphedema.
“For women with no suspicious, palpable axillary nodes who undergo breast-conserving therapy, there is little evidence of benefit from surgical complete axillary node dissection compared with sentinel biopsy alone,” wrote the researchers.