Sentinel node biopsy is done during surgery to remove early-stage breast cancer. This biopsy is done to see if cancer has spread to the lymph node closest to the breast cancer (called the sentinel node). This information can help your doctor decide whether or not the lymph nodes under the arm need to be removed. Removing all or most of the under-arm lymph nodes is called axillary lymph node dissection.
The very large study reviewed here found that a number of non-medical factors seem to make it more likely that the under-arm lymph nodes will be removed without a sentinel node biopsy being done first. These factors are:
During surgery to remove breast cancer, surgeons can use their hands to find the sentinel node. To identify the sentinel node more accurately, they often inject a dye or radioactive material where the cancer is and then follow the path of the dye or radioactive material to the sentinel node. Once it's identified, the sentinel node is removed and evaluated by a pathologist, who determines if cancer is in the node.
If cancer has spread to the sentinel node, a surgeon can be more confident that removing the lymph nodes under the arm is necessary. When the sentinel node has no cancer, a surgeon can be more confident that the lymph nodes under the arm don't need to be removed. Not removing the lymph nodes under the arm usually minimizes risks and complications after breast cancer surgery, including the risk of arm swelling (lymphedema).
Deciding whether or not to do sentinel node biopsy should be determined by medical factors. The study reviewed here found this doesn't seem to be happening all of the time. The researchers don't say why the non-medical factors appear to influence the sentinel node biopsy decision. It's possible that there are medical factors associated with the non-medical factors that may explain some of it, but the researchers didn't find this. Unfortunately, it's also likely that age, social, and economic factors might be distorting doctors' opinions about who would or would not benefit from sentinel node biopsy.
If you're going to have surgery to remove early-stage breast cancer, ask your surgeon about how it will be decided whether the cancer has spread to your lymph nodes. Ask whether a sentinel node biopsy will be done. If your surgeon plans on doing an axillary node dissection without doing a sentinel node biopsy first, ask why, and make sure the explanation makes sense to you. If you're uncomfortable with the surgeon's answer or recommendations, seek out a second opinion.
Visit the breastcancer.org Sentinel Lymph Node Dissection page to learn more about sentinel node biopsy, who can benefit from this technique, and how it is performed.
NEW YORK (Reuters Health) - The likelihood that a woman with early breast cancer will undergo a staging procedure called sentinal lymph node biopsy is largely influenced by her age, ethnicity, and insurance status, and not by the relevant disease factors, new research indicates.
Axillary lymph node dissection, which involves removing all lymph nodes in the armpit, has been the traditional operation to determine whether cancer has spread beyond the breast. Sentinal lymph node biopsy, by contrast, is a newer, less extensive procedure in which only a single "sentinel" node in the armpit is removed to determine if the cancer has spread.
Better outcomes are associated with sentinal lymph node biopsy compared with axillary lymph node dissection, including decreased arm swelling and pain. According to Dr. Amy Y. Chen, with the American Cancer Society in Atlanta, and colleagues, little is known about factors that influence the choice of procedure.
They examined these issues using the National Cancer Database, which covers facilities approved by the American College of Surgeons Commission on Cancer. Their study included 491,000 patients with breast cancer who underwent surgical treatment including lymph node sampling between 1998 and 2005.
The use of sentinal lymph node biopsy increased from 26.8 percent in 1998 to 65.5 percent in 2005, Chen and her colleagues report in the Journal of the National Cancer Institute.
Age over 72 years, belonging to a racial/ethnic minority, and having Medicaid or no health insurance were all associated with undergoing axillary lymph node dissection rather than sentinal lymph node biopsy. Not graduating from high school and a lower household income were also predictive of undergoing the more extensive operation.
The research team examined trends over time and found that, in contrast to disparities that existed in 2005, some factors, including older age, income, and health insurance status, were not associated with the chances of undergoing sentinal lymph node biopsy in 1998. The disparities associated with minority status widened.
"Even when we controlled for low income and health insurance status, racial disparities still persisted," Chen added. "It is concerning to see that as dissemination of sentinal lymph node biopsy increased across all facility types, racial and socioeconomic status disparities increased."
However, because the database does not include individual hospital characteristics, she added, they could not tell if "disproportionate groups of poorer individuals, for example, seek medical care at facilities that do not offer sentinal lymph node biopsy."
These findings imply, the authors state, that "those who are more likely to receive axillary lymph node dissection may lack resources to deal with the added burdens associated with its adverse effects."
SOURCE: Journal of the National Cancer Institute, April 2, 2008.
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