UR Oncologist Leads Panel on Guidelines for Performing Lymph Node Biopsies in Early Stage Breast Cancer

September 13, 2005

Gary Lyman, M.D., M.P.H.

A nationwide panel of oncologists, led by a University of Rochester Medical Center doctor, today issued recommendations for the use of a less-invasive technique to determine if early stage breast cancer has spread. 

Gary H. Lyman, M.D., M.P.H., led the American Society of Clinical Oncology’s (ASCO) effort to assess the benefits of using sentinel lymph node biopsy (SNB), which is the removal of a few lymph nodes near the breast, and long-time standard axillary lymph node dissection -- the removal of more than 20 nodes -- to assess disease progression.

The multidisciplinary ASCO guideline panel concluded that SNB can be safely used instead of axillary lymph node dissection in most women with early stage breast cancer who do not have clinically suspicious lymph nodes — usually meaning that the doctor cannot feel them during an examination. SNB is associated with fewer and milder long-term side effects than axillary node dissection. However, it is not yet known whether SNB has a positive effect on long-term survival in cancer patients.

“Sentinel node biopsy often saves women from invasive surgery, allowing them to return to their daily activities much quicker. It’s a simpler process, and its effectiveness has been proven,” says Lyman, lead contributor to the guideline and director of Health Services and Outcomes Research at the James P. Wilmot Cancer Center of the University of Rochester Medical Center.

The guideline, published online Sept. 12 by the Journal of Clinical Oncology, was developed following a two-year systematic review of literature on the use of SNB in early stage breast cancer.

Oncologists use the SNB procedure to determine whether cancer has spread outside of the breast. When cancer spreads from the breast, it travels through the patient’s lymphatic system into the lymph nodes, which are tiny glands that fight infection and disease. The first lymph node or group of lymph nodes encountered is called the sentinel node.

To locate the sentinel node, the surgeon injects a weak radioactive substance that is not harmful to the patient, and/or a blue dye into the breast. As opposed to full axillary lymph node dissection in which 20 to 25 lymph nodes are removed and examined, in SNB a smaller number of lymph nodes, usually between one and three, are removed and examined.

If the results of the SNB are negative for cancer, an axillary lymph node dissection is not needed, as long as an experienced surgical team has performed the procedure. However, if the results of the SNB show evidence of cancer, then a complete dissection of lymph nodes in the armpit is needed to determine how far the cancer has spread.

Because more lymph nodes are studied in an axillary lymph node dissection, the doctor may have more confidence concerning how far the cancer has spread. However, this procedure can result in long-term complications or disabilities, including pain and numbness in the arm and lymphedema, characterized by excess fluid in the arm that causes swelling.

“Knowing whether the cancer has spread helps determine the stage and optimal approach to treatment,” says Lyman, a breast oncologist. “Patients whose cancer has spread to the lymph nodes may be treated differently than those where it has not spread to the lymph nodes.”

ASCO also released a new evidence-based patient guide, Sentinel Node Biopsy in Early Stage Breast Cancer. This guide is the patient version of the clinical practice recommendations and is available on ASCO’s patient website People Living With Cancer, at www.PLWC.org.

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