This Test May Stop Unneeded Lymph Node Surgery

Ultrasound may help determine need for lymph node surgery in breast cancer patients

(RxWiki News) Although they may at the time be cancer-free, some breast cancer patients have their lymph nodes removed to ensure the cancer doesn't come back and spread. That surgery, however, may not always be needed. Ultrasound may play a role in avoiding unnecessary lymph surgery.

A new study found that ultrasound may help doctors and patients determine when it is necessary to remove the lymph nodes of breast cancer patients.

When women with breast cancer find that their cancer has spread to surrounding lymph nodes, they often receive chemotherapy, followed by surgery. This surgery may remove the breast tumor along with lymph nodes to ensure that the cancer does not spread. Lymph nodes are part of the body's lymph system, which drains fluids from tissue.

According to Adam Brufsky, MD, PhD, professor of medicine at the University of Pittsburgh School of Medicine, this is an interesting study of surgical management of the armpit lymph nodes after initial chemotherapy for breast cancer.

Dr. Brufsky, who was not involved in this study, told dailyRx News that this ultrasound technique could spare some women from a full axillary dissection, or removal of a significant amount of armpit lymph nodes. Instead, they can undergo sential lymph node dissection, a less invavise surgery in which the lymph nodes closest to the breast cancer are removed.

"This has the potential to change clinical practice in these patients, with the caveat that the ultrasonographer needs to be very experienced in this area," Dr. Brufsky said.

“That’s one of the really nice things about giving chemotherapy up front: It allows us to be less invasive with surgery, both in terms of breast surgery and lymph node surgery, and to tailor treatment based on response to chemotherapy,” said lead study author Judy C. Boughey, MD, a breast surgeon at the Mayo Clinic in Rochester, MN, in a press release.

Dr. Boughey told dailyRx News, "With improvements in understanding tumor biology and use of targeted therapy, we increasingly see in women treated with chemotherapy prior to surgery that all the disease has been eradicated from the armpit nodes at the time of surgery after chemotherapy. Since we are becoming more successful with eradicating disease from the lymph nodes, it leads us to question whether all these women need to have [lymph node surgery], which removes the majority of the lymph nodes from under the arm."

Dr. Boughey and team studied more than 600 patients who had node-positive cancer, meaning it had spread to the lymph nodes. These patients received chemotherapy (strong medications created to kill fast-growing cancer cells), followed by ultrasound imaging. Ultrasound uses high-frequency sound waves to make images of the inside of the body.

Based on the ultrasound results after chemo, these patients were classified as having normal or suspicious nodes. These patients then received tests to determine the status of their nodes.

Of the 181 patients whose ultrasound results suggested they might have cancer in their lymph nodes, 130 (about 72 percent) were node-positive at surgery, meaning at least one of the nodes in the armpit had cancer. Of the 430 thought to have normal lymph nodes based on their ultrasounds, 243 (56.5 percent) were found to be node-positive.

Abnormal lymph nodes on the ultrasound after chemotherapy predicted a raised risk of lymph node cancer and a “greater nodal disease burden,” according to Dr. Boughey and team.

These researchers added that patients with normal lymph nodes on ultrasound exams had a much lower risk of having residual disease. Some did have signs of the disease but to a lesser extent than others, with fewer positive nodes and smaller metastases (malignant growths that have spread from the primary site of the cancer).

If cancer has spread to the lymph nodes under the arm, surgeons often remove all of these nodes. Removing nodes, however, can lead to complications, such as swelling in the arm called lymphedema and limits to the range of arm motion.

Dr. Boughey said that the improvements in targeted therapy and chemo medications have helped eliminate cancer in the lymph nodes from many women before they go to surgery.

Ultrasound after chemotherapy may help surgeons determine whether they should remove only a few nodes and test them for cancer or take out all the nodes. This screening process may help identify nodes that are cancer-free, sparing the patient more extensive surgery.

This study was published Feb. 2 in the Journal of Clinical Oncology.

Funding sources and conflict of interest disclosures were not available at the time of publication.

Review Date: 
February 2, 2015