Acceptance of Sentinel Node Biopsy Is Growing

City of Hope
Tuesday, 14 October 2003

Surgeons are routinely performing on women with early stage breast cancer an investigational procedure called sentinel node biopsy (SNB)—used to check one or more lymph nodes at greatest risk for breast cancer metastases—which may be affecting the information-gathering process of clinical trials of the procedure, a research team has found. Their findings appear in the October 15 issue of the Journal of the National Cancer Institute.

"Whether widespread SNB use represents good clinical judgment or an example of premature adoption of an inadequately tested new technology is a question that may only be resolved years from now and if the ongoing trials provide definitive data on the outcomes of the technique," said Joyce C. Niland, Ph.D., chair, Division of Information Sciences, City of Hope Cancer Center, a co-author of the study. Stephen B. Edge, M.D., Roswell Park Cancer Institute, Buffalo, N. Y., was the primary author of the study.

Large trials are underway in the U.S. and elsewhere to examine the safety and accuracy of SNB, but the procedure is gaining popularity among doctors and patients at five comprehensive cancer centers whose SNB use was studied. Niland said there is concern that premature adoption of SNB as a standard of care may compromise these trials.

SNB is considered an alternative to standard axilary node dissection (AND), which involves removing all of the lymph nodes in the armpit area and causes temporary, partial loss of use of the arm. AND also has been associated with lymphedema, swelling caused by the accumulation of lymph fluid.

While not yet a standard of care, SNB use was associated in the study period with breast-conserving surgery at five academic and comprehensive cancer centers, the researchers said. They looked at 3,003 women with stage I or stage II breast cancer who underwent SNB alone, SNB followed by AND, AND alone, or no surgery at one of five comprehensive cancer centers.

The study period was 1997 to 2000, when SNB was entering U.S. clinical practice. During that time, SNB use increased while AND alone or after SNB decreased.

The study, titled "Emergence of Sentinel Node Biopsy in Breast Cancer as Standard-of-Care in Academic Comprehensive Cancer Centers," derived from the National Comprehensive Cancer Network's (NCCN) Oncology Outcomes Database that was created by City of Hope in 1996. The central database is located at City of Hope, the data coordinating center for the NCCN.

"This study demonstrates the power of the pooled NCCN database to track trends in patterns of treatment for cancer care on a national scale," Dr. Niland said.

The study was funded by the NCCN. The NCCN research team included Rebecca Ottesen, M.S., City of Hope; Michael A. Bookman, M.D., Fox Chase Cancer Center, Philadelphia; Richard L. Teriault, D.O., M. D. Anderson Cancer Center, Houston; Eva Lepisto, M.S., National Comprehensive Cancer Network; Rocklidge, PA; and Jane C. Weeks, M.D., Dana-Farber Cancer Institute, Boston.

For more information, or to contact City of Hope, see their website at: www.cityofhope.org