Removal of armpit lymph nodes can leave many breast cancer patients with lingering lymphedema, a painful and unsightly swelling of the arm.
Now, new Swedish research may help narrow down which patients require extensive lymph removal, based on the number and size of tumors infiltrating lymph nodes"We want to perform less extensive procedures, to spare patients from troublesome side effects. But we need to know that it's safe," explained study lead author Jana de Boniface, a researcher at the department of molecular medicine and surgery at the Karolinska Institute, in Stockholm.
There's already been some progress made in determining whether extensive lymph removal is always necessary.However, when no such spread is suspected, doctors typically only remove and test a few "sentinel" nodes, to see if they contain any traces of thecell or cancerous spots that are less than two millimeters in size -- further excision of the nodes is not required.
But what if the node biopsy turns up metastases that are larger than 2 millmeters in one or two sentinel nodes?patients from five countries. All had metastases that were larger than 2 millimeters in one or two of their sentinel nodes. About half of the group were randomly chosen to undergo more complete armpit node removal, while nodes for the other half of patients were left undisturbed.deal with any stray cancer lurking in the lymph nodes of all the patients, the Stockholm team said.
There was a downside to opting for more radical lymph removal: 13% of patients who'd done so went on to experience debilitating"Our assessment is that it is safe for patients to forgo axillary dissection if there are a maximum of two macrometastases in the sentinel lymph nodes," de Boniface said in a Karolinska news release."This has now been implemented in clinical practice in Sweden," de Boniface noted.
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