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23 July 2008
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Delayed and immediate ALND equivalent for early breast cancer
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MedWire News: Breast cancer patients who undergo delayed axillary lymph node dissection (ALND) after a previous positive sentinel lymph node (SLN) biopsy show no greater morbidity than patients who undergo both procedures in a single operation, US study findings reveal.
The findings will reassure surgeons treating patients who wish to defer a decision regarding ALND and cases where SLN metastasis are only found after more detailed analysis following biopsy.
Lead researcher John Olson (Duke University Medical Center, Durham, North Carolina) and colleagues explain that SLN biopsy is an accepted alternative to ALND for disease staging in patients with early-stage breast cancer. Patients found to have metastasis in the SLN(s) generally undergo completion ALND immediately in the same operation, they add.
Occasionally, a delayed approach to completion ALND is taken not only because of failure of intraoperative detection of SLN metastasis, but also to allow for a review of the pathology and to obtain patient input in axillary management decisions.
However, it is unclear whether delayed ALND is associated with greater morbidity than the immediate procedure, which itself carries a risk for complications such as lymphedema, arm paresthesia, chronic pain, and immobility in 5% to 50% of patients.
In the present study, the researchers followed-up 425 breast cancer patients who had immediate ALND after a positive SLN biopsy finding and 578 patients who had delayed ALND a median of 19 days after SLN biopsy.
As reported in the Journal of Clinical Oncology, rates of complications were very similar in the two groups after 1 year of follow-up. Paresthesia was reported in 36% of immediate ALND patients and 38% of delayed ALND patients, while lymphedema was reported in 14% and 12%, and immobility in 6% and 5% in the respective groups.
Of note, short-term complications at 30 days of follow-up were actually reduced in the delayed ALND group, with 35% of patients suffering paresthesia compared with 51% of patients in the immediate ALND group.
Discussing their findings, Olson et al say that although delayed ALND does not add extra physical complications "there is considerable added cost and emotional stress to the patient associated with additional surgical procedures."
"We emphasize that it is best to use intraoperative SLN assessment and perform completion ALND when SLN metastases are found intraoperatively," they add.
J Clin Oncol 2008; 26: 3530-3535
http://jco.ascopubs.org/cgi/content/abstract/26/21/3530
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