Our Summary

This study looked at whether removing lymph nodes in the armpit (axillary staging) during breast cancer surgery affects the patient’s chances of survival. The researchers divided over 5,000 patients with a certain type of breast cancer into two groups: one group had their lymph nodes removed (surgery group) and the other group did not (surgery-omission group). The researchers found that the survival rates after five years were roughly the same in both groups. They also found that the surgery-omission group had a slightly higher risk of cancer recurrence in the lymph nodes, but a lower risk of death. Additionally, the surgery-omission group had fewer side effects, such as swelling (lymphedema), pain, and limited arm movement. The study concludes that for patients with this type of breast cancer, leaving the lymph nodes in place during surgery does not appear to harm survival rates and may reduce side effects.

FAQs

  1. Does removing lymph nodes during breast cancer surgery affect a patient’s chances of survival?
  2. What are the potential side effects of removing lymph nodes during breast cancer surgery?
  3. Does leaving the lymph nodes in place during surgery affect the risk of cancer recurrence in the lymph nodes?

Doctor’s Tip

A helpful tip a doctor might tell a patient about sentinel lymph node biopsy is that it is a minimally invasive procedure that helps determine if cancer has spread beyond the primary tumor. During this procedure, only a few lymph nodes are removed, reducing the risk of complications such as lymphedema. It is important to discuss the risks and benefits of this procedure with your healthcare provider to make an informed decision about your treatment plan.

Suitable For

Patients with early-stage breast cancer, particularly those with small tumors and no signs of lymph node involvement, are typically recommended sentinel lymph node biopsy. This procedure helps determine if cancer has spread to the lymph nodes without the need for a full axillary lymph node dissection, which can lead to side effects such as lymphedema and decreased arm mobility. Sentinel lymph node biopsy is also recommended for patients with certain types of breast cancer, such as hormone receptor-positive or HER2-positive tumors, to help guide treatment decisions and assess the risk of cancer recurrence.

Timeline

Before the sentinel lymph node biopsy:

  1. Patient is diagnosed with breast cancer and undergoes various imaging tests and biopsies to determine the extent of the disease.
  2. The patient’s medical team discusses treatment options, including the possibility of a sentinel lymph node biopsy to determine if the cancer has spread to the lymph nodes.
  3. If the decision is made to proceed with the biopsy, the patient undergoes a pre-operative evaluation and preparation for surgery.

After the sentinel lymph node biopsy:

  1. The patient undergoes the biopsy procedure, which involves injecting a dye or radioactive tracer near the tumor to identify the sentinel lymph node.
  2. The surgeon removes the sentinel lymph node and sends it to the pathology lab for analysis.
  3. The patient may experience some discomfort, swelling, and bruising at the biopsy site after the procedure.
  4. The pathology results are reviewed to determine if the cancer has spread to the lymph nodes. Depending on the results, further treatment decisions may be made.
  5. The patient follows up with their medical team for ongoing monitoring and management of their breast cancer treatment plan.

What to Ask Your Doctor

  1. What is a sentinel lymph node biopsy and why is it recommended for me?
  2. What are the risks and benefits of having a sentinel lymph node biopsy?
  3. How will the results of the biopsy impact my treatment plan?
  4. What are the chances of cancer recurrence in the lymph nodes if I choose not to have a sentinel lymph node biopsy?
  5. What are the possible side effects of a sentinel lymph node biopsy and how can they be managed?
  6. Are there any alternative options to a sentinel lymph node biopsy that I can consider?
  7. How will the results of the sentinel lymph node biopsy affect my overall prognosis and chances of survival?
  8. How experienced are you in performing sentinel lymph node biopsies and what is your success rate?
  9. Are there any specific follow-up care or monitoring required after a sentinel lymph node biopsy?
  10. Are there any ongoing clinical trials or research studies related to sentinel lymph node biopsies that I should be aware of?

Reference

Authors: Reimer T, Stachs A, Veselinovic K, Kühn T, Heil J, Polata S, Marmé F, Müller T, Hildebrandt G, Krug D, Ataseven B, Reitsamer R, Ruth S, Denkert C, Bekes I, Zahm DM, Thill M, Golatta M, Holtschmidt J, Knauer M, Nekljudova V, Loibl S, Gerber B. Journal: N Engl J Med. 2025 Mar 13;392(11):1051-1064. doi: 10.1056/NEJMoa2412063. Epub 2024 Dec 12. PMID: 39665649