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Breast cancer unfortunately commonly spreads
to the lymph nodes under the armpit (axilla).
The presence or absence of cancer in these
nodes is the most important prognostic
factor for women with potentially curable
breast cancer. Most general surgeons today
continue to surgically remove all of these
lymph nodes to determine tumor stage in
an operation referred to as an axillary
dissection. This operation is associated
with morbidity, including arm swelling,
decreased shoulder mobility, and underarm/chest-wall
numbness. Although more limited axillary
dissections are associated with decreased
post-operative morbidity, these types
of operations may compromise the accuracy
of staging.
Others and we have pioneered an alternative
to this traditional approach which is
a technique referred to as sentinel lymph
node mapping. By using a combination of
blue dye and a radioisotope, surgeons
can follow the lymphatic channels draining
a breast cancer to a lymph node ("sentinel
node"), which is surgically removed
in a much less invasive operation. We
have demonstrated that the presence or
absence of breast cancer in this sentinel
lymph node accurately determines whether
the breast cancer has spread to the axilla.
The ability of a surgeon to find the sentinel
node(s) during surgery is highly dependent
on the number of these operations he/she
has performed. Sentinel lymph node mapping
surgery is less invasive than the traditional
approach of removing all lymph nodes,
and is therefore associated with less
morbidity. Another potential advantage
of this sentinel lymph node mapping is
that the pathologists can focus their
analysis on sentinel lymph nodes, rather
than on numerous lymph nodes removed from
the axilla. They are therefore able to
examine more areas of the lymph node and
use special stains. These techniques have
been demonstrated to identify microscopic
foci of breast cancer that are missed
by standard techniques.
Between 18% and 35% of patients with stage
I and II breast cancer will have spread
of their disease to axillary lymph nodes.
In many cases, the only node containing
cancer will be the sentinel lymph node.
It is unknown whether complete removal
of axillary lymph nodes in these patients
improves local control or enhances odds
of survival. Several published series
have shown that radiation therapy alone
is effective in controlling recurrence
in the axilla.
The goals of this clinical trial are:
- Determine the lymph node recurrence
rates in patients with cancer in their
sentinel lymph node that undergo axillary
radiation
- Assess reduction in morbidity associated
with sentinel lymph node mapping compared
to traditional full axillary dissection
- Determine the frequency with which
breast cancer is identified in sentinel
lymph nodes using more sensitivity
pathologic analytic methods.
If you are interested in learning more
about lymphatic mapping for treatment
of your breast cancer, or if you would
like more information on this clinical
trial, please contact:
Beth Sawyer, PA at 617-724-4800
Michele A. Gadd, MD
Division of Surgical Oncology
Massachusetts General Hospital
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