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| Tumor detection shows promise
Less painful biopsy for breast cancer
By KATHY WILLIAMS, Staff Writer
Detecting the spread of breast cancer in women with large tumors may have just become easier.
Typically, surgeons remove 10 or more lymph nodes from the patient's armpit to look for the spread of cancer. The painful operation sometimes causes swelling, numbness and infection.
But new research released this week by the UNC School of Medicine says a less invasive surgery now used with small tumors is also effective.
"There are a few individual centers using it on large tumors," said Dr. David W. Ollila, a UNC surgeon and researcher. "Now we need a national study."
Lymph node dissection is much like interviewing the eyewitnesses closest to the crime scene. Instead of removing 10 or more lymph nodes and analyzing all of them to look for cancer, this procedure removes only the node that is closest to the cancer and most likely to have it.
If this node, called the sentinel, is clean, chances are the other nodes have not been affected.
The new study from the medical school is published in the September issue of the American Journal of Surgery. It shows that sentinel-node biopsy, when performed before chemotherapy is given to shrink the tumor, is very reliable, the UNC researchers said.
The study suggests that sentinel-node biopsy is an option that might benefit all women with breast cancers, said Ollila, associate professor of surgery at UNC and a member of the UNC Lineberger Comprehensive Cancer Center.
"I think any woman diagnosed with breast cancer should ask her physician what role this technique might play in her overall treatment," Ollila said.
He acknowledged the controversy in medical circles about the surgery, which uses a dye injection to stain the first affected lymph node.
Dr. Rosa Cuenca, a surgical oncologist at East Carolina University's Brody School of Medicine, said the procedure has been controversial for large tumors. She compares large tumors to wrecked cars on the freeway. When the dye used in the procedure can't get down the road, sometimes it goes around on other pathways, identifying the wrong lymph nodes.
Also, some surgeons advocate performing the sentinel-node biopsy procedure in women with large tumors only after chemotherapy, to discover how much of the tumor remains. However, results of UNC researchers show that performing the procedure before treatment provides a more accurate picture of lymph node involvement, Ollila said.
Subjects in the study were 21 breast cancer patients with tumors large enough in relation to the size of the breast that the breast could not be preserved.
Such patients usually get chemotherapy to shrink the tumor before surgery, to decrease chances of recurrence and, for a small number of women, to make it feasible to have a lumpectomy rather than a mastectomy. In the UNC tests, researchers performed sentinel-node biopsy before chemotherapy, modifying the technique slightly for larger cancers.
If the test procedure showed disease in the sentinel node or if the tumor was larger than five centimeters in diameter, all the nodes were removed and the patient received chemotherapy and surgery. If the biopsy showed tumor-free sentinel nodes and the tumor was less than five centimeters, no further lymph nodes were removed and the patient received chemotherapy and tumor removal.
In an average of 36 months of post-treatment follow-up, none of the patients showed progression of cancer in the lymph nodes. The sentinel-node biopsy accurately predicted node involvement, Ollila said.
Staff writer Kathy Williams may be reached at 829-4567 or kwilliam@newsobserver.com.
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