by Maychai Brown

For years it was thought that removal of axillary (armpit) lymph nodes was necessary to stop the spread of breast cancer. The surgical procedure had many potential side effects – infection, limitation of arm movement, recurring pain, and lymphedema.

Results of a randomized clinical trial reported February 9 in the Journal of the American Medical Association indicate that removal of multiple axillary lymph nodes has no better outcome when compared with removal of just one or two of the sentinel nodes (the first draining nodes nearest to the tumour).  The research cohort was limited to women who had stage 1-2 tumours with metastasis to the lymph nodes. All the women in the trial had undergone removal of the sentinel node(s), an integral step in diagnosing metastasis. All were treated by lumpectomies followed by whole breast irradiation. The women were then randomized into two groups – one to have no further treatment and one to undergo removal of ten or more axillary lymph nodes. After five years, the survival rate in the group which had multiple lymph nodes removed was 91.8% with 82.2% experiencing no recurrence of disease, whereas the survival rate of the group which had only the sentinel nodes removed was 92.5% with no recurrence experienced by 83.9% of this group.

Randomized Clinical Trial Abstract: http://jama.ama-assn.org/content/305/6/569.short

New York Times February 8, 2011: http://www.nytimes.com/2011/02/09/health/research/09breast.html