Is axillary dissection always necessary ?

« Some patients with early-stage breast cancer may be able to safely forego full axillary lymph node dissection, reducing their risk of adverse effects. »(1)

A US trial(2) « enrolled 891 women with histologically confirmed early-stage invasive breast cancer, no palpable adenopathy, and one or two sentinel lymph nodes containing cancer cells. Patients underwent sentinel lymph node dissection and were then randomized to undergo dissection of the remaining axillary nodes or to receive no further axillary intervention. All patients underwent lumpectomy and tangential whole-breast radiation. Adjuvant therapy was at the discretion of the treating physician. »(1)

The results suggest that complete axillary lymph node dissection may no longer be justified in women with one or two positive sentinel nodes and a tumor of 5 cm or smaller. Overall survival was 92.5 % (sentinel node dissection) and 91.8 % (full dissection) at five years.

« Sparing this group of patients full dissection may reduce their risk of developing long-term and later adverse effects, including impaired limb mobility, lymphedema, chronic pain, and neurologic symptoms. »(3) Although removal of fewer lymph nodes reduces the risk of later adverse effects, it doesn’t eliminate it. « New technology, such as infrared perometry and symptom assessment, may enable early detection of later adverse effects. »(3)