Node Dissection and Micromets
This is a study that may not be of widespread interest but, for those of us who fall into this particular group, is is important. Igor Langer and his colleagues at University Hospital in Lausanne, Switzerland have just published a study examining the value of performing full axillary lymph node dissection (ALND) vs sentinel node dissection (SND) for women who have a micromet in the sentinel node.
In 1993, when I was first diagnosed with breast cancer, SND did not exist, and a full axillary dissection was the standard of care. My surgery did find a micro-met, and, although that probably did not change the full treatment (since I was scheduled for chemotherapy anyway), it has left me with greater concerns and vigilance re possible lymphedema than I would have had otherwise. The usual practice today is asking women to return for more surgery, ALND, if a sentinel node is found to have even a micromet.
Here is a quote from the article and then a link if you want to read more:
Axillary lymph node dissection (ALND) may be safely omitted in patients with early stage breast cancer and sentinel lymph node (SLN) micrometastases, according to a study published recently by Igor Langer and colleagues (Department of Surgery, University Hospital Lausanne, Lausanne, Switzerland) in Annals of Surgical Oncology (2009 Sep 4. [Epub ahead of print]. PMID: 19760047).
The question of whether to perform ALND has been controversial since the use of SLN mapping and sensitive immunohistochemical tests for identifying micrometastases (and isolated tumor cells) became widespread. "Seeing metastases larger than 2 mm, now that matters.
With micrometastases (clusters of cancer cells larger than 0.2 mm but not larger than 2 mm) or isolated tumor cells (individual cells or cell clusters no larger than 0.2 mm), the prognosis is as if the patient were node-negative. That's a very important message," explains Victor Vogel, MD,
MHS. "You don't have to do extensive axillary dissections in those patients. Removing micromets [micrometastases] surgically does not add to the systemic treatment of patients with breast cancer." Dr. Vogel is the American Cancer Society's national vice president for research.