Sparing Lymph Nodes

Breast cancer patients with node negative SLN biopsies only fare well

(RxWiki News) It used to be that when a woman was diagnosed with breast cancer, typical treatment included removal of the breast and nearby lymph nodes.

Today, women with early stage breast cancers have only a few lymph nodes closest to the tumor – sentinel lymph nodes - removed to see if the disease has spread. This procedure is called a sentinel lymph node biopsy.

Women who have SLN biopsies and no evidence of disease - as is commonly seen - tend to live as well as women who have had all nearby lymph nodes removed.

This same study also showed that examining the tissue with a particular screen is not meaningful.

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Researchers from the John Wayne Cancer Institute in Santa Monica, Cedars-Sinai Medical Center and the Samuel Oschin Comprehensive Cancer Institute collaborated on this study designed to learn the long-term outlook for women who had received only a SLN biopsy.

Lymph node tissue is evaluated for the presence of cancer. If the disease has traveled to these vessels that wind around throughout the body, this is not a good sign. It means the cancer has a way of moving to other parts of the body.

To screen for cancer in lymph nodes, clinicians use two tests. One test is called a hematoxylineosin (HE) stain. The other test is more advanced and looks at various proteins. This test is called immunohistochemistry (IHC).

This study looked at 811 women who had undergone surgery to treat invasive breast cancer between May 1, 1995 and December 31, 2002. All study members had had a SLN biopsy and all had HE-negative SLN (absence of disease according to HE screen).

The women were mostly in their late 50s, had a median of two SLNs removed and were followed for about 8.5 years.

Here’s what the researchers found:

  • Just over 9 percent of the women had a breast cancer recurrence (return).
  • Only 0.2 percent of women developed cancer in axiliary lymph nodes.
  • Median time to recurrence was about 57 months (4.75 years).
  • 5-year disease-free survival (DFS) was 95 percent.
  • 10-year DFS was 90 percent.
  • Higher-grade and larger tumors in older women were more likely to return.
  • 100 women died.
  • The immunohistochemistry (IHC) test did not provide predictive data.

Adam Brufsky, MD, PhD, professor of medicine at the University of Pittsburgh School of Medicine, told dailyRx News, “This study continues to demonstrate the safety and efficacy of sentinel lymph node biopsy and appears to confirm that IHC on the sentinel node adds no additional information,”

The authors concluded, “This study reports the long-term follow-up of patients with breast cancer and hematoxylineosin-negative, tumor-free SLNs, showing a remarkably low axillary recurrence of 0.2% and high disease-free survival. Long-term results of SLN biopsy alone are excellent, and the addition of immunohistochemistry analysis does not contribute to survival.”

They go a step further and recommended, “These long-term data are consistent with those of prior published studies and support that patients with HE-negative SLNs should be managed without axillary lymph node dissection and without additional IHC stains of their lymph nodes.

This study was published November 19 in the Archives of Surgery.

The research was supported by Associates for Breast and Prostate Cancer Studies, Santa Monica, California; QVC and the Fashion Footwear Association of New York Charitable Foundation and the Margie and Robert E. Petersen Foundation.

No conflicts of interest were reported.

Review Date: 
November 20, 2012