Sentinel lymph node biopsy is as accurate as axillary lymph node dissection for staging breast cancer and has a lower complication rate, according to an article in the May issue of The Archives of Surgery.

Axillary lymph node dissection, the standard for staging clinically node-negative disease, has complication rates of 20 percent to 55 percent, including arm lymphedema, nerve damage, hemorrhage, and localized edema. Previous studies have suggested that the simpler procedure of sentinel node biopsy might be as effective or not more so.

In the current study, D. Kay Blanchard, M.D., Ph.D., and her American colleagues compared the rates of complications and post-biopsy metastasis in women who underwent sentinel node biopsy with the rates in women who underwent both biopsy procedures.

A total of 1,253 women with primary invasive breast cancer who underwent sentinel node biopsy between October 14, 1997 and August 31, 2001 were studied. Of the total, 164 women underwent axillary node dissection after sentinel node biopsy as part of a training program for surgeons. Patients were contacted by questionnaire or telephone to determine outcomes such as breast cancer relapse, presence of arm lymphedema, arm pain, axillary infection or localized swelling, and tumor recurrence or death.

Of 1,253 women, 894 (71 percent) had node-negative disease by sentinel lymph node biopsy alone (730 women, 82 percent) or sentinel node biopsy plus axillary node dissection (164 women, or 18 percent). Questionnaires were completed by 776 women (87 percent) with an average follow-up period of 2.4 years.

Researchers found that women who underwent axillary node dissection reported a significantly higher rate of complications than patients who underwent only sentinel node biopsy: 34 percent of women who underwent both procedures reported arm lymphedema (versus 6 percent), 38 percent reported arm pain (versus 14 percent), 24 percent reported localized swelling (versus 7 percent), and 9 percent reported infection (versus 3 percent). Among the 685 patients who underwent sentinel node biopsy only, only 1 patient’s disease later spread to an axillary node.

"The present study demonstrated significantly decreased rates of both complications [lymphedema and arm pain] plus a minimal prevalence of axillary relapse in patients who underwent sentinel lymph node biopsy only compared with those who underwent sentinel lymph node biopsy plus axillary lymph node dissection," wrote the authors. "These data provide strong support for sentinel lymph node biopsy as the staging method of choice for patients with clinically diagnosed node-negative breast cancer."