Axillary lymph nodes
No need for removal of all axillary lymph nodes for some patients with a positive sentinel node biopsy – Over the past ten years fewer and fewer patients with breast cancer have needed to have all of their lymph nodes removed from under the arm. This has been a very positive step forward because this type of surgery can cause permanent fluid retention in the arm (lymphoedema).
Monday 20th February 2012
Until very recently patients whose sentinel node biopsy was clear of cancer spread did not need to have any more lymph nodes taken out, but if there was any sign of spread to the lymph nodes a full axillary clearance, meaning removal of all the lymph nodes under the arm, was advised.
This would be expected to produce the side effect of lymphoedema in about 10% of women. Now two new studies have shown that even if there is some spread in to the axillary lymph nodes, some patients can safely avoid having any more of the lymph nodes taken out.
The decision as to whether further lymph node surgery is require depends on the amount of spread in to the original sentinel node. This is classified by pathologists in to three groups. Isolated tumour cells, which is just very small groups of cancer cells amounting to a total of less than 0.2mms in maximum diameter, micro metastases defined as areas of cancer within the lymph node of between 0.2 and 2mms and macro metastases which are larger tumour deposits, more that 2mms.
Some surgeons already ignore the isolated tumour cells, regarding the lymph node as essentially negative. The new studies have shown that patients with micro metastases in to their sentinel node have no benefits from having further lymph node surgery. If the sentinel node biopsy shows only micro metastases it is safe to leave the rest of the lymph nodes. Figures show no increase in the rate of recurrent cancer within the lymph nodes under the arm and no change in the cure rates for the breast cancer as a whole.
The two new studies include large numbers of patients and the results are convincing. At the Harley Street Breast Clinic we now advise that patients with micro metastases in their sentinel nodes do not need any further lymph node surgery. In this way we hope that the number of patients developing lymphoedema can be reduced still further by avoiding a full axillary node clearance.