The results of a new prospective trial indicate that axillary lymph node dissection may not be necessary in some women with early stage breast cancer with positive sentinel lymph nodes. Sentinel node biopsy eliminates the need for axillary node dissection in patients whose sentinel node is negative for cancer. However, for patients with positive lymph nodes, axillary node dissection remains the accepted standard of care. Axillary dissection achieves regional control, but its effect on survival is not well established.
In the study, 891 early stage breast cancer patients who underwent sentinel node biopsy were assigned either to receive axillary dissection or no further axillary-specific treatment. All patients were treated with lumpectomy and standard radiotherapy (which typically only partially irradiates the axillary region). Chemotherapy and other adjuvant systemic therapy was given as appropriate. Women assigned to the sentinel node biopsy alone group had a median of two lymph nodes removed whereas the axillary dissection group had a median of 17 lymph nodes removed.
The rate of five-year recurrence in the breast after axillary dissection was 3.7% compared to 2.1% for sentinel node biopsy, whereas five-year nodal recurrence was 0.6% in the axillary dissection group compared to 1.3% in the sentinel node group. The findings demonstrate no trend toward clinical benefit of axillary dissection for patients with limited nodal disease. The authors conclude that sentinel lymph node dissection without axillary node dissection can offer excellent regional control and may be reasonable management for selected patients with early-stage breast cancer treated with lumpectomy and adjuvant systemic therapy.