A new decision-making model developed by
Dr.Giovanni Parmigiani and colleagues at Duke University has shown
that the routine use of axillary lymph node dissection may not be
necessary for many breast cancer patients. Recently, the use of
axillary dissection has been questioned because lymph node status may
not alter adjuvant therapy and because the survival benefit resulting
from a change in adjuvant therapy would be small.
Only a Select Group of Patients May Benefit
The decision-making model was developed to quantify the survival
benefits of axillary lymph node dissection in breast cancer patients
receiving breast-conserving therapy. According to the model, axillary
dissection only provides a small survival benefit in this population
and is of greatest benefit to estrogen receptor positive women with
small primary tumors who might not be eligible for adjuvant
chemotherapy because their lymph nodes are negative. The model
suggests that routine use of axillary lymph node dissection should be
reassessed, and may be necessary only in select groups of patients.
Axillary lymph node dissection can cause numbness, swelling, and a
decreased range of motion of the shoulder. Because of these side
effects, sentinel node biopsy is currently being examined as a less
Future studies will explore the use of the decision model as a
counseling tool to help physicians and patients make better informed
decisions regarding axillary lymph node dissection.