Lymph Node Surgery Not Needed for Certain Small Breast Cancers
People diagnosed with early-stage breast cancer no larger than 2 centimeters (about three-quarters of an inch) in size and ultrasound results that show no cancer in the lymph nodes can safely skip lymph node surgery, according to a study.
The research was published online on Sept. 21, 2023, by the journal JAMA Oncology. Read “Sentinel Lymph Node Biopsy vs No Axillary Surgery In Patients With Small Breast Cancer and Negative Results on Ultrasonography of Axillary Lymph Nodes: The SOUND Randomized Clinical Trial.”
About lymph node surgery
Lymph nodes in the armpit area are called axillary lymph nodes.
There are two types of lymph node surgery (also called lymph node dissection or lymph node biopsy) done during breast cancer surgery:
axillary lymph node dissection, which usually removes between five and 30 lymph nodes
sentinel lymph node dissection, which removes the one or two lymph node closest to the breast cancer
If cancer is in the lymph nodes, you have a higher risk of cancer cells in other parts of your body.
The more lymph nodes removed, the higher the risk of lymphedema, the abnormal swelling that happens when the lymphatic system is damaged. So doctors are always trying to keep the number of lymph nodes removed as low as possible, while still offering the best care.
About the study
The study, called the SOUND trial, included 1,405 women diagnosed with early-stage breast cancer between February 2012 and June 2017.
The women were ages 52 to 68 and treated at hospitals in Italy, Spain, Switzerland, and Chile.
All of them had breast cancers that were smaller than 2 centimeters, ranging in size from 0.8 to 1.5 centimeters.
All the women had an ultrasound that showed cancer wasn’t in the lymph nodes.
All the women were scheduled to have lumpectomy followed by radiation therapy.
Before lumpectomy surgery, the women were randomly split into two groups:
708 women had sentinel lymph node surgery along with lumpectomy
697 women had no lymph node surgery, only lumpectomy
Follow-up time was about six years.
During follow-up:
1.7% of women who had sentinel lymph surgery and 1.6% of women who didn’t have lymph node surgery had the cancer come back (recur) in the breast area
1.8% of women who had sentinel lymph node surgery and 2% of women who didn’t have lymph node surgery had a distant, or metastatic, recurrence, meaning the cancer came back in a part of the body away from the breast, such as the bones or liver
3% of women who had sentinel lymph node surgery and 2.6% of women who didn’t have lymph node surgery died
After five years, similar percentages of women were alive with no cancer recurrence, called disease-free survival by doctors:
94.7% of women who had sentinel lymph node surgery were alive with no recurrence
93.9% of women who had no lymph nodes surgery were alive with no recurrence
Five-year overall survival rates (the percentage of women alive after five years, whether or not the cancer recurred) were:
98.2% for women who had sentinel lymph node surgery
98.4% for women who had no lymph node surgery
The researchers’ analysis showed that there was no statistical difference in outcomes between women who had sentinel lymph node surgery and women who had no lymph node surgery.
“In this randomized clinical trial, omission of [lymph node] surgery was non-inferior to [sentinel lymph node surgery] in patients with small breast cancer and a negative result on ultrasonography of the axillary lymph nodes,” the researchers concluded. “These results suggest that patients with these features can be safely spared any [lymph node] surgery whenever the lack of pathological information does not affect the post-operative treatment plan.”
What this means for you
“This is an important study,” said Marisa Weiss, MD, Breastcancer.org founder and chief medical officer. “To date, most of the patients with early-stage breast, favorable-subtype breast cancer still get sentinel lymph dissections, yet most of them have no lymph node involvement. Additionally, there are real risks with this procedure, such as being under extended general anesthesia, pain and discomfort, and lymphedema.
“If we can reliably identify which patients are unlikely to have lymph node involvement and can avoid lymph node removal,” she continued, “we can help more people have fewer complications from treatment and an improved quality of life.”
If you’ve been diagnosed with breast cancer that is smaller than 2 centimeters and an ultrasound shows no cancer in the lymph nodes, you may want to talk to your surgeon about this study and ask whether skipping lymph node surgery makes sense for your unique situation.
— Last updated on January 25, 2024 at 6:44 PM