July 1, 2011


COLUMBIA, Tenn. — A new study may bring welcome news to many women diagnosed with early stage breast cancer, according to John P.W. Brown, M.D., a surgeon on the medical staff at Maury Regional Medical Center.

With improvements in technology such as digital mammography, Brown indicates that clinicians are able to detect cancers in much earlier stages than in years past. Women diagnosed with early stage breast cancer often choose breast conservation surgery known as a lumpectomy, local removal of the cancerous mass and a margin of tissue surrounding the site. During the lumpectomy, the sentinel lymph node—the first lymph node in the series of those located underneath the arm—is removed for testing. The procedure is commonly referred to as a sentinel node biopsy and is a key indicator to determine if the cancer has spread beyond the breast.

In the past, any positive sentinel lymph node was followed by a complete removal of all of the lymph nodes from under the arm, known as axillary dissection. The lymph nodes would then be tested for the presence of cancer. This operation was associated with a significant risk of arm lymphedema, a condition in which the arm retains fluid and the tissue swells as a result of the compromised lymphatic system. A new clinical trial demonstrates that some women with two or fewer positive sentinel lymph nodes do not need further lymph node removal, according to Brown.

“The results of this long-awaited six-year clinical trial were presented at the American Society of Clinical Oncology last summer. Many found the results surprising and practice-changing. Women who are found to have only two or three minimally involved nodes at the time of the sentinel node biopsy are no longer recommended to have the remaining lymph nodes removed, eliminating the need for invasive surgery and greatly decreasing the side effect of lymphedema,” said Brown.

The American College of Surgeons Oncology Group conducted the Z11 trial among 900 sentinel node positive patients. It was documented that there was no benefit in local cancer site control or survival rates for those who had further lymph node removal.

“Not having to go back to remove more lymph nodes in the face of a few positive sentinel lymph nodes is a major breakthrough. This is great news for women with early stage breast cancer who qualify,” said Brown.