Some patients With breast cancer can forego axillary dissection.

A new study has shown that women with early breast cancer and positive lymph nodes lived just as long whether they had sentinel lymph node dissection (SLND) plus axillary lymph node dissection (ALND) or SLND alone. Complete ALND for patients with breast cancer has been standard practice; how-ever, results of the new study could help end a long-running debate over the role of SLND in the management of early breast cancer.

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The 900-patient randomized, prospective trial found the five-year overall survival rate was 91.8% for patients with SLND and ALND compared to 92.5% with SLND alone, and the five-year disease-free survival was 82.2% with SLND and ALND compared to 83.9% with SLND alone. The results apply only to a subgroup of patients with the clinical characteristics of those in the trial: stage T1-T2 breast cancer with no palpable adenopathy and one or two sentinel nodes treated with breast-conserving surgery, whole-breast irradiation, and adjuvant systemic therapy. Even limited to this subgroup, the study findings could improve clinical outcomes in thousands of women each year by reducing ALND and its complications and improving quality of life with no decrease in survival.

Giuliano, A.E., Hunt, K.K., Ballman, K.V., Beitsch, P.D., Whitworth, P.W., Blumencranz, P.W, ... Morrow, M. (2011). Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: A randomized clinical trial. JAMA, 305, 569-575.

doi: 10.1001/jama.2011.90