Traditional breast surgery involves removing lymph glands in the armpit to determine if the cancer has spread and if further treatment is necessary. This can stop the lymph fluid from draining properly, resulting in persistent lymphoedema, which can lead to grossly swollen and painful arms and loss of mobility in the affected limbs. Between 10% and 20% of breast cancer patients are affected to some degree by lymphoedema after breast surgery and radiotherapy.
The new technique is designed to restrict lymph gland or node removal to cases in which the cancer has actually drained from the breast to the sentinel node, the first node into which breast cancer spreads - if it spreads at all. Professor Veronesi, who is based in Milan, outlined the development at the ECCO 11 European Cancer Conference in Lisbon.
A radioactive tracer is injected close to the tumour and carried by the lymphatic system into the sentinel node. This enables the surgical team to locate the node's position. A biopsy then establishes if the cancer has spread into the node - and if further surgery is necessary.
A study of 500 patients has shown that the new technique is as effective as routine dissection which removes all lymph nodes in the axilla, most of which are totally healthy in women with early cancer. Professor Veronesi told the conference: "The early results show that the sentinel node policy is able to detect the cases of positive (cancerous) axillary (armpit) nodes in a percentage equal to that obtained with the routine axillary dissection.
"We conclude that probe-guided biospy of the sentinel node is easy to apply, that the techniques are easy to learn and that the whole procedure is associated with a low risk of false negatives. We suggest that the technique should be widely adopted. Large-scale implementation of it will reduce the cost of treatment by reducing the time women spend in hospital. It will also reduce indirect costs because "motor compromise' and lymphoedema as a result of axillary dissection will disappear".
Current treatment of lymphoedema includes massage to stimulate drainage lymph and the wearing of a compression sleeve to remove the lymph component of the swelling if carried out early enough. However, in long-standing cases where fatty tissue hypertrophy (enlargement) has developed, it is not always successful.
A Swedish team has developed a novel type of liposuction to remove the fatty tissue and accumulated lymph via about 20 small (2mm) incisions along the arm. In a study of 64 patients with severe lymphodoema, the team typically removed about two litres of fat from the arms of the patients via liposuction. But the patients were still instructed to wear a compression sleeve permanently, taking it off only for a short time for special occasions - in other words, prevention will always be better than partial cure.
Abstract No. 51
Further information: Maria Maneiro
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