Lymph Node Test Doesn't Improve Breast Cancer Care, Study Finds
Cancer cells found by special staining in first node to which disease typically spreads did not affect survival
By Maureen Salamon
TUESDAY, July 26 (HealthDay News) -- A special staining process that often accompanies a lymph node-sparing test is not associated with longer survival times for women with early-stage breast cancer treated with breast-conserving surgery, a large, new study suggests.
Examining the medical records of more than 5,200 patients who underwent breast-conserving surgery for early, invasive breast cancer, researchers found that tiny cancer cells in the sentinel lymph node -- the first node to which malignant cells are likely to spread from a primary tumor -- detected with a diagnostic procedure called immunohistochemical (IHC) staining had no effect on overall survival.
The biopsy procedure, known as sentinel lymph node (SLN) dissection, has been praised for averting the removal of large numbers of armpit lymph nodes during breast cancer surgery, which can lead to a painful buildup of fluid called lymphedema.
In this new study, the researchers wanted to determine the association between immunochemical staining of SLNs and bone marrow specimens taken from patients with early-stage breast cancer, and those patients' survival and risk for metastatic cancer.
"I think I'd have to say it was highly controversial whether these occult [hidden] metastases would be clinically relevant," said study author Dr. Armando Giuliano, chief of surgical oncology at Cedars-Sinai Medical Center in Los Angeles. "If it's not going to affect mortality, it shouldn't affect treatment."
The study is published in the July 27 issue of the Journal of the American Medical Association.
The observational study included data from women included in the American College of Surgeons Oncology Group trial at 126 sites from May 1999 to May 2003, and all patients were followed until April 2010. Results were blinded to treating physicians to avoid the bias of overtreatment, Giuliano said.
At a midpoint follow-up of 6.3 years, 435 women had died and 376 experienced recurrence of their cancer. Based on IHC staining, five-year overall survival rates of those whose samples tested positive for node involvement were 95.1 percent, compared to 95.7 percent for those whose SLN biopsies tested negative. Corresponding five-year rates of disease-free survival were 90.4 percent and 92.2 percent, respectively.
Giuliano said the research, when adopted clinically, can save patients several hundred dollars or more in unnecessary tests. Women with microscopic metastases in their SLNs can also be spared from certain more aggressive treatments that were thought to increase their survival rates, he said.
Dr. Lora Weiselberg, chief of breast cancer service at the Monter Cancer Center of North Shore-LIJ Health System in Lake Success, N.Y., said many physicians have questioned the significance of the use of IHC for all sentinal lymph node biopsies.
"In certain cases . . . we would want to do [IHC staining] anyway, but otherwise I think this is very strong evidence," Weiselberg said. "I think more and more pathology laboratories are going to go in that direction [of fewer tests] because adding another costly test, if it's not going to help the patient, is unnecessary."
The U.S. National Cancer Institute has more on sentinel lymph node biopsies.SOURCES: Armando Giuliano, M.D., chief, surgical oncology, and executive vice chair, surgery for surgical oncology, Cedars-Sinai Medical Center, Los Angeles; Lora Weiselberg, M.D., chief, breast cancer service, Monter Cancer Center, North Shore-LIJ Health System, Lake Success, N.Y.; July 27, 2011, Journal of the American Medical Association Related Articles
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