I participated in a clinical trial in 1998, comparing SNB to AND. Since it was still in the trial stages, I underwent sentinel node biopsy, followed by full axillary node dissection. This allowed the physicians to compare their findings. The end result was the same for me - I was about to undergo axillary dissection, so why not let them take the primary node first and add to their statistics.
The ALMANAC trial was conducted in Great Britain, through the Middlesex Hospital in London. The study set out to find if there was a distinct advantage for women who had a positive sentinel node should undergo complete axillary dissection and/or radiation. Fifty percent of the patient enrolled in the study had the sentinel node identified as the only site of regional nodal metastasis. There seemed to be no survival advantage to either radiotherapy or axillary lymph node dissection. The morbidity for each individual was then taken into consideration. With either treatment, there could be cosmetic and/or functional issues, such as arm edema and should function impairment.
The study compares upper limb morbidity following axillary radiotherapy with complete axillary lymph node dissection in patients with sentinel node metastasis.
515 patients were enrolled in the study between November 1999 and October 2003. These patients all had node negative invasive breast cancer and underwent senintenl node biopsy. Sentinel node metastases were found in 120 patients. 75 of these patients had full axillary dissection and 28 received axillary radiotherapy. Patients were followed at 1, 3, 6, 12, and 18 months post-operatively.
Patients were assessed for sensory deficit, lymphedema, breast edema via questionnaire. Objective measurements were made of upper and forearm circumference. Shoulder mobility and sensory deficit were assessed.
The results showed that axillary dissection increased sensory loss, which remained at the 18 month follow-up. Those who received radiation had significant impairment in shoulder flexion and abduction at the 18 month mark. However, no significiant difference was found in shoulder rotation, upper limb lymphedema or breast edema.
The trial's investigators conclude that axillary dissection may be preferable and that AND may lead to lower rate of axillary recurrence.
The study, in my opinion, was not extremely large and I have not read the full documentation to understand if other factors,which could affect the outcomes, were taken into consideration.
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