Less Can Be More When Removing Lymph Nodes During Breast Cancer Surgery

Not long ago, breast cancer patients whose tumors had spread to their lymph nodes were routinely advised to have all the lymph nodes in their armpits removed as a precautionary measure. But now research from UT Southwestern, published in the Journal of the American Medical Association, validates that a more conservative approach causes less harm to patients and often yields the same results.

The newer methodinvolves a biopsy of the node closest to the tumor, known as the sentinel node. A positive sentinel lymph node biopsy can be used to determine the stage of the cancer while sparing the network of axillary lymph nodes, which are distributed at the edge of the chest muscles and into the armpits and lower neck.

Avoiding axillary surgery if possible is important, says Roshni Rao, M.D., Associate Professor of Surgery, because it can cause shoulder and arm symptoms, including lymphedema, severe pain or numbness, and reduced range of motion, and it generally involves longer stays in the hospital compared to sentinel node surgery.

Dr. Rao and her colleagues at UT Southwestern’s Harold C. Simmons Cancer Center have determined that, in patients with no suspicious axillary nodes who undergo breast-conserving therapy (a partial mastectomy followed by whole-breast radiation), sentinel node biopsy can be just as effective as axillary surgery for staging the cancer and determining a course of treatment.

“Now that decisions regarding chemotherapy are often guided by molecular tumor profiling in an era of personalized medicine,” says Dr. Rao, “there are other avenues to explore beyond aggressive surgeries.”

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