New Study Recommends Avoiding Unnecessary Removal of Lymph Nodes in Breast Cancer
Researchers from Heidelberg University Hospital and the University of Lucerne, along with international scientists, patient representatives, and European cancer societies, have conducted a comprehensive study on the surgical management of lymph nodes in breast cancer. The findings, published in the open access journal eClinicalMedicine, aim to guide medical professionals in avoiding unnecessary removal of lymph nodes and sparing breast cancer patients from chronic lymphedema.
The study highlights the significant benefits of preoperative chemotherapy in breast cancer treatment. It can effectively shrink tumor size and metastatic lymph nodes before surgery, enabling breast surgeons to avoid complete excision of axillary lymph nodes. This approach reduces the risk of distressing side effects, such as arm lymphedema.
To address the challenges of clinical axillary lymph node management in early breast cancer, a multidisciplinary consortium composed of European cancer societies, international medical institutions (including Heidelberg University), and patient representatives came together. Leading experts voted on important issues and formulated recommendations for clinical application.
The consortium developed five work packages that covered the patient’s journey from diagnosis to local axillary therapy, focusing on specific clinical scenarios. Professor Dr. Peter Dubsky, the head of the Breast Center at the Hirslanden Klinik St. Anna in Lucerne and the lead investigator of the consortium, emphasized the need to reduce the number of lymph nodes removed in the axilla to minimize the risk of harming lymphatic drainage from the arm.
The international working group not only complemented existing guidelines but also created a new medical concept with practical recommendations designed to prevent unnecessary surgical removal of lymph nodes. These recommendations can be easily integrated into clinical practice, providing clinicians with a valuable resource.
During a conference held in Lucerne in September 2022, the participating experts achieved a consensus on a previously controversial debate and developed a practical guide. They voted on 72 statements, reaching consensus in 52.8% of the cases, a majority agreement in 43.1%, and no decision in 4.2%.
After analyzing the voting results, the working group proposed that imaging and standardized pathology of the lymph nodes should be a prerequisite for planning local and systemic therapy in breast cancer patients. In the majority of scenarios discussed, the removal of all axillary lymph nodes could be replaced by the targeted removal of a few specific lymph nodes, such as the sentinel lymph nodes.
The outcome of lymph node surgery has complex implications for subsequent radiation, chemotherapy, or hormone therapy, which should be tailored to each individual patient. Therefore, the recommendations emphasize the importance of monitoring the success of these guidelines by recording and evaluating the risk of cancer recurrence and side effects experienced by individual women.
The culmination of these recommendations is The Lucerne Toolbox. The project was sponsored by the Hirslanden Klinik St. Anna in Lucerne, and its first edition was published in 2021, addressing the issue of mastectomy.
The new study on the surgical management of lymph nodes in breast cancer provides valuable insights and practical recommendations for medical professionals. By avoiding unnecessary removal of lymph nodes, patients can be spared from chronic lymphedema, improving their quality of life after breast cancer treatment. With the integration of these recommendations into clinical practice, breast cancer patients can benefit from tailored treatment plans that minimize the risk of side effects and optimize their chances of recovery.
