Patients with breast cancer that undergo a selective sentinel lymph node biopsy have a better quality of life 12 months after surgery than those submitted to lymph node dissection. This is the conclusion reached by a group of researchers from the Hospital del Mar-Esperança and the IMIM (Hospital del Mar Medical Research Institute).
The sentinel lymph node surgical technique has been used for years to avoid lymph node dissection when treating patients with breast cancer that has not spread. The sentinel lymph node is the first in a lymphatic chain that drains the area where there is a tumour. The lymph coming from this area must first go through this lymph node before it can continue to the remaining nodes, meaning this is the node with the highest probabilities of having an initial metastasis. Detecting whether there are tumour cells in this node will be essential to avoid the disease from spreading. If the results from this sentinel lymph node are negative, this can avoid a lymph node dissection.
“Until now, there was a slight controversy as to the benefits in terms of the quality of life of patients undergoing a sentinel lymph node biopsy compared to a lymph node dissection.” says Roser Belmonte, a doctor at the Department of Physical Medicine and Rehabilitation at Hospital del Mar-Esperança and a researcher at IMIM. One of the problems was that “many of the tools used to measure the quality of life did not take into account the complications that frequently occur such as lymphedema (retention of lymphatic liquid) or other problems in the upper limb (armpits, shoulder, arm, forearm and hand). That is why we looked for a new tool that included problems in the upper limb”, Belmonte adds.
The study involved monitoring 93 patients with breast cancer from before operating to 12 months after undergoing surgery. From these patients, 64 underwent the sentinel lymph node technique and 29 underwent lymph node dissection. Researchers carried out physical examinations on the patients to assess whether they had problems in shoulders, arms or the area where surgery was done and to see if there was any lymphatic liquid retention. They also evaluated the quality of life of these patients using FACTB+4, a questionnaire that includes the impact of discomforts in the upper limb. Finally, they compared the group that underwent the sentinel lymph node technique with the group that underwent a lymph node dissection and they were able to see that patient that had undergone a lymph node dissection showed poorer results in terms of quality of life.
Breast cancer has a higher prevalence in women in developed countries; in Spain the incidence is around 81 new cases per year for every 100,000 women. It is estimated that Spanish women have a risk of developing breast cancer at some stage in life that is around 6-9%, and the survival rate after 5 years is around 85%. This means there is a large number of women who have been treated for breast cancer and allowing them to have a good quality of life is one of the primordial goals. Researchers believe it is necessary to have a specific control for patients that have undergone lymph node dissection to prevent and treat complications in the upper limb and, whenever possible, to use the sentinel lymph node technique to ensure a better quality of life.
These results justify the relevance of improving prevention, treatment and management of lymphedema, currently one of the main complications occurring in breast cancer since it is chronic and has a high impact on the quality of life. Today, thanks to the breast screening programme, most breast cancers are detected at the initial stages and can be operated on using the sentinel lymph node technique, thus avoiding complications in arms and facilitating a better recovery and quality of life of patients.
Article of reference:
“Quality of life impact of sentinel lymph node biopsy versus axillary lymph node dissection in breast cancer patients“. Roser Belmonte, Olatz Garin, Marcel Segura, Angels Pont, Ferran Escalada, Montserrat Ferrer. Value in Health Doi: 10.1016/j.jval.2012.06.003.
Institut Hospital del Mar d’Investigacions Mèdiques