Researchers embrace sentinel lymph node biopsy.(Gynecology)

SAN ANTONIO -- Sentinel lymph node biopsy is as accurate as the traditional surgical practice of dissecting the entire axillary lymph node chain in women with breast cancer but inflicts far less nerve damage and fewer other complications. Mark Kissin, M.Chir., reported during a breast cancer symposium sponsored by the Cancer Therapy and Research Center.

The results of the first large-scale randomized trial of sentinel lymph node biopsy in breast cancer patients featuring comprehensive functional and quality of life assessment are so compelling that British health officials who have seen the data have directed that all U.K. surgeons undergo formal training in the technique, according to Dr. Kissin.

"There shouldn't really be a choice anymore. Sentinel node biopsy, for the patient, should be the standard of care," he declared.

Dr. Kissin was a coinvestigator in the Axillary Lymphatic Mapping Against Nodal Axillary Clearance (ALMANAC) trial, a multicenter U.K. study in which 1,031 women with clinically node-negative breast cancer were randomized to sentinel lymph node biopsy (SLNB) or to the traditional surgical practice of dissecting the entire axillary lymph node chain. Surgeons who participated in the trial were required to have under-gone systematic training in SLNB with demonstrated technical competence in its performance.

ALMANAC featured both patient assessments of functional status and quality of life as well as objective measurements of arm and shoulder morbidity, anxiety, and resource utilization at 1, 3, 6, 12, and 18 months. The 6-month follow-up data were the focus of presentations at the San Antonio meeting, although the 18-month data are being processed and should be available soon.

Only one-quarter of patients assigned to SLNB proved SLN-positive.

That means three-quarters of women who undergo routine axillary node clearance needlessly experience the considerable associated morbidity that was documented in ALMANAC. Dr. Kissin, who is a surgeon at Royal Surrey County Hospital in Guildford, England, explained at the meeting.