Drawbacks of sentinel node dissection
"The need for additional treatment (surgery, radiation, or both) if the sentinel node turns out to be involved represents a key limitation of the sentinel lymph node approach. Many doctors favor the traditional lymph node approach, just to avoid the situation where another treatment is needed to deal with remaining nodes that may be involved with cancer. This reinforces the importance of carefully selecting the right procedure for the each individual woman. If you have a significant risk of having lymph nodes involved in the cancer—based on your initial staging information and what the surgeon found during your surgery—you would be best served by traditional lymph node dissection."
—Marisa Weiss, M.D.
Benefits of sentinel node dissection
With sentinel node dissection, a surgeon may only have to remove one lymph node, or a small cluster of two or three nodes, to know whether or not breast cancer has spread to the axilla (underarm). This procedure leaves the other non-involved, functional lymph nodes intact. The procedure allows critical treatment insights with the least possible surgery and trauma.
There are many good reasons why women want to minimize the number of underarm lymph nodes that are removed. Lymph node surgery can lead to uncomfortable temporary side effects, such as lymph backup in the armpit, called seroma. Other side effects can linger, including mild armpit discomfort and numbness in the armpit and the upper arm, and swelling of the arm on the side of the affected breast, called lymphedema. The swelling of lymphedema can involve the breast area as well as the armpit. Finally, the more surgery a woman has in the breast/armpit area, the more potential for numbness, heightened sensitivity, and discomfort.
Therefore, in appropriate women, the sentinel node procedure is an important step in the right direction. It's an intelligent way to identify the node(s) that are at highest risk for involvement with breast cancer. It works well in many women who have early-stage disease with a relatively low risk of lymph node involvement.
Strategic removal of just one or a few key underarm nodes can accurately assess their overall lymph node status in women who have relatively small breast cancers (less than or equal to 2 centimeters) without abnormal feeling lymph nodes before surgery. Studies with follow-up of just less than 5 years, show that women who had just the sentinel node removed lived just as long and were just as likely to be free of cancer as the women who had more lymph nodes removed. Longer follow-up will help us better understand the long-term pros and cons of sentinel lymph node dissection.