Removing Fewer Lymph Nodes May Reduce Lymphedema Risk in Breast Cancer

Breast cancer surgery has evolved significantly over the years, with one advancement being the shift away from traditional axillary lymph node dissection to the more targeted approach of sentinel lymph node biopsy.

Historically, surgeons removed a large number of lymph nodes from the armpit to determine if cancer has spread. This procedure, while effective, often led to lymphedema, a condition characterized by swelling in the arm. With sentinel lymph node biopsy, surgeons can identify and remove only the first few lymph nodes that drain the breast.

CURE spoke with Dr. Allison A. DiPasquale, director of breast oncology at Texas Breast Specialists-Medical City in Dallas, to learn more about how sentinel lymph node biopsy has become a more common approach in breast cancer surgery.

Transcript:

So in the beginning, … they knew cancer went from the breast to the lymph nodes, so they just took out a big glob of lymph nodes, creating lymphedema for women. So that was called an axillary dissection, and they took out not — I mean, I remember when I first started, we wanted as many nodes as we could. We felt, as surgeons, the more nodes we got, the better that patient would do. But we know now that's not true, because our systemic therapy, meaning the body therapy, the pills, the medicines, all the other stuff we do to keep the patients cancer free, works so good.

So that's where the sentinel nodes started developing, which is the first draining lymph node from the breast. I always call it the gatekeeper to the body, because usually the breast will drain to the armpit in about 95% of the time, and they will have one, two, maybe three, first draining lymph nodes, and then it disseminates to all the others. There's 20-plus nodes underneath the armpit there.

So the sentinel node has really allowed us to hone in on those first draining lymph nodes. If they don't have cancer, then none of the others do. We don't have to take them all out. And so that helps us reduce the problems that can come from surgery, including lymphedema.

For more news on cancer updates, research and education, don’t forget to subscribe to CURE®’s newsletters here.