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Less Invasive Biopsy for Breast Cancer Backed

Study favors looking at telltale lymph nodes in armpits

(HealthDay is the new name for HealthScout News.)

WEDNESDAY, Aug. 6, 2003 (HealthDayNews) -- For much of the last century, women with aggressive breast cancer have been advised to have their armpit tissue removed, a clean-sweep operation intended to prevent the disease from spreading further.

Doctors are now rethinking that strategy, thanks to the development five years ago of a far less invasive procedure. The new approach looks for signs of cancer in the so-called "sentinel" lymph nodes, which are the first to collect fluid and cells draining from breast tumors. If these nodes are positive for cancer then the armpit, or axillary, tissue is removed. If not, it's left intact.

While important questions about the procedure remain unanswered, a new study suggests it may be a safe and accurate alternative to the brute force surgery of old. The study followed 516 women with small breast tumors (less than about an inch in diameter), of whom half had the low-impact procedure and half had the conventional operation.

After five years, the two groups had roughly the same odds of their cancer spreading to a different organ, the researchers say. Yet women who underwent sentinel-node biopsy reported much less pain and nerve problems, and much better arm mobility, than the others in the study.

A report on the findings appears in the Aug. 7 issue of the New England Journal of Medicine.

Previous research has shown sentinel node samples are incorrectly negative between 5 percent and 15 percent of the time, a relatively high figure. The Italian study had a false negative rate of about 8 percent.

Still, Dr. Umberto Veronesi, director of the European Institute of Oncology in Milan and leader of the research, believes that in the long run the procedure may save more lives than removing all the lymph nodes. "We believe that leaving normal lymphatic tissue [in the armpit] will help protect women and help patients do better," Veronesi says.

Dr. David Krag, a University of Vermont cancer surgeon who helped develop the sentinel-node biopsy, says two major questions about the surgery remain: Do the savings in side effects and discomfort over conventional surgery come at the price of an increased risk of death? And does it offer inferior control of cancer in the breast itself?

Two studies now under way should answer those questions definitively, says Krag, co-author of an editorial accompanying the journal article. Each is a head-to-head comparison of sentinel-node surgery with axillary tissue removal. Krag is running one of the trials, which has enrolled more than 5,000 women and includes more than 200 surgeons.

"Until those studies are completed, we really won't have that information," says Krag. He expects to see results in "a couple of years."

More than 211,000 women in the United States will be diagnosed with breast cancer this year, and 40,000 will die of the disease, according to the American Cancer Society. One in three cases of breast cancer spreads to the lymph nodes, Krag says. All or nearly all patients with disease in their lymph nodes would be eligible for sentinel-node biopsy "if studies prove there's no price paid in survival," he says.

More information

For more on sentinel-node biopsy, try the M.D. Anderson Cancer Center. For more on breast cancer, visit the American Cancer Society.

SOURCES: Umberto Veronesi, M.D., professor, surgery, University of Milan, and director, European Institute of Oncology, Milan, Italy; David Krag, M.D., professor, surgery, University of Vermont, Burlington; Aug. 7, 2003, New England Journal of Medicine
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