Removal sentinel node has no impact on survival.

For years I have been wondering why lymph glands should be "touched" [removed] in cases of breast[cancer].[and in fact I advised against it]

I asked it to some colleagues and never go even a partially logic answer.

We all now that lymph glands serve as a "police-station" to prevent spread of infections and diseases [they may become swollen and try to keep things localized!]

With the article below you will see again how illogical medicine sometimes is practised.

I have NO IDEA where this concept of lymph gland removal started. If any of you know I would be happy to hear.

Really: shev we al ta-ase ["zit en doe niets"] ]is not only applicable in halacha.

Reported August 8, 2011

Rethinking Breast Cancer Approach

(Ivanhoe Newswire) -- A new study shows removing lymph nodes because of the presence of microscopic cancer cells found in the sentinel node has no impact on survival among women with early-stage breast cancer.

Researchers studied more than 5,000 women with breast cancer at 126 sites around the country. All the participants underwent breast-conserving surgery and sentinel lymph node dissection. The sentinel lymph node is the one that is closest to the tumor.

Results showed survival outcomes were no different between women who underwent total lymph node removal and those who only had the sentinel lymph node removed.

“This study shows that the presence of tiny sentinel lymph node metastases has no bearing on survival outcomes,” Armando E. Giuliano, M.D., of Cedars-Sinai Medical Center, was quoted as saying.

Researchers say this finding could spare women the pain and side effects of comprehensive lymph node removal. Removing lymph nodes can cause complications such as lymphedema, which is a chronic and often painful swelling in the arm that can be debilitating.

“Treating the patient doesn’t end with stopping the cancer,” Dr. Giuliano said. “We want to make sure we maximize the patient’s quality of life even after cancer treatment is completed."

SOURCE: Journal of the American Medical Association, August 2011 

Lymph node test doesn't improve breast cancer care

Updated: Aug 02, 2011 5:36 PM

© iStockphoto / Thinkstock

By Maureen Salamon
HealthDay Reporter

TUESDAY, July 26 (HealthDay News) -- A special staining process that often accompanies a lymph node-sparing test is not associated with longer survival times for women with early-stage breast cancer treated with breast-conserving surgery, a large, new study suggests.

Examining the medical records of more than 5,200 patients who underwent breast-conserving surgery for early, invasive breast cancer, researchers found that tiny cancer cells in the sentinel lymph node -- the first node to which malignant cells are likely to spread from a primary tumor -- detected with a diagnostic procedure called immunohistochemical (IHC) staining had no effect on overall survival.

The biopsy procedure, known as sentinel lymph node (SLN) dissection, has been praised for averting the removal of large numbers of armpit lymph nodes during breast cancer surgery, which can lead to a painful buildup of fluid called lymphedema.

In this new study, the researchers wanted to determine the association between immunochemical staining of SLNs and bone marrow specimens taken from patients with early-stage breast cancer, and those patients' survival and risk for metastatic cancer.

"I think I'd have to say it was highly controversial whether these occult [hidden] metastases would be clinically relevant," said study author Dr. Armando Giuliano, chief of surgical oncology at Cedars-Sinai Medical Center in Los Angeles. "If it's not going to affect mortality, it shouldn't affect treatment."

The study is published in the July 27 issue of the Journal of the American Medical Association.

The observational study included data from women included in the American College of Surgeons Oncology Group trial at 126 sites from May 1999 to May 2003, and all patients were followed until April 2010. Results were blinded to treating physicians to avoid the bias of overtreatment, Giuliano said.

At a midpoint follow-up of 6.3 years, 435 women had died and 376 experienced recurrence of their cancer. Based on IHC staining, five-year overall survival rates of those whose samples tested positive for node involvement were 95.1 percent, compared to 95.7 percent for those whose SLN biopsies tested negative. Corresponding five-year rates of disease-free survival were 90.4 percent and 92.2 percent, respectively.

Giuliano said the research, when adopted clinically, can save patients several hundred dollars or more in unnecessary tests. Women with microscopic metastases in their SLNs can also be spared from certain more aggressive treatments that were thought to increase their survival rates, he said.

Dr. Lora Weiselberg, chief of breast cancer service at the Monter Cancer Center of North Shore-LIJ Health System in Lake Success, N.Y., said many physicians have questioned the significance of the use of IHC for all sentinal lymph node biopsies.

"In certain cases . . . we would want to do [IHC staining] anyway, but otherwise I think this is very strong evidence," Weiselberg said. "I think more and more pathology laboratories are going to go in that direction [of fewer tests] because adding another costly test, if it's not going to help the patient, is unnecessary."

More information

The U.S. National Cancer Institute has more on sentinel lymph node biopsies.