Axillary Dissection May Be Unnecessary for Many Breast Cancer Patients

A new decision-making model developed by Dr.Giovanni Parmigiani and colleagues at Duke University has shown that the routine use of axillary lymph node dissection may not be necessary for many breast cancer patients. Recently, the use of axillary dissection has been questioned because lymph node status may not alter adjuvant therapy and because the survival benefit resulting from a change in adjuvant therapy would be small.

Only a Select Group of Patients May Benefit

The decision-making model was developed to quantify the survival benefits of axillary lymph node dissection in breast cancer patients receiving breast-conserving therapy. According to the model, axillary dissection only provides a small survival benefit in this population and is of greatest benefit to estrogen receptor positive women with small primary tumors who might not be eligible for adjuvant chemotherapy because their lymph nodes are negative. The model suggests that routine use of axillary lymph node dissection should be reassessed, and may be necessary only in select groups of patients.

Axillary lymph node dissection can cause numbness, swelling, and a decreased range of motion of the shoulder. Because of these side effects, sentinel node biopsy is currently being examined as a less invasive alternative.

Future studies will explore the use of the decision model as a counseling tool to help physicians and patients make better informed decisions regarding axillary lymph node dissection.