CHAPEL HILL, N.C. - A multi-center study published in The New England Journal of Medicine last October showed that sentinel lymph node biopsy - the removal of some of the first lymph nodes into which cancerous cells from the breast might drain - is as effective for determining the spread of disease as totally removing all the lymph nodes under the arm.
That journal report and subsequent media coverage helped trigger an ongoing demand for sentinel lymph node biopsy among women diagnosed with invasive breast cancer.
These patients are candidates for either breast-preserving therapy or mastectomy. They see in sentinel node biopsy an alternative to complete axillary (armpit) lymph node resection, or lymphadenectomy. This major operation requires general anesthesia with its attendant risks. It also often results in persistent numbness and tingling in the armpit and, in some patients, causes swelling of the arm to twice its size, requiring special care for life.
The demand for the new biopsy also has prompted a surge in requests from community-based surgeons for lessons in the technique, says Dr. David Ollila, assistant professor of surgery at the University of North Carolina at Chapel Hill School of Medicine and a member of the UNC Lineberger Comprehensive Cancer Center.
"Use and demand for this technique is truly exploding across the country, yet the whole field is very young," he says. "The first description of the technique in breast cancer patients was less than five years ago."
Ollila and his UNC-CH colleagues in surgical oncology note that sentinel lymph node biopsy is technically challenging to perform and that its success rate could vary widely among surgeons and institutions. They urge breast cancer patients seeking to avoid complete axillary resection to first ask about the "false negative rate" of their surgeon and medical institution.