Axillary Lymph Node Status

There is nothing better to assess axillary lymph node status than sentinel lymph node biopsy. PET scanning has been tried. This involves radioactive glucose injected into the patient's venous system. This radioactive glucose is taken up by cancer more readily than non-cancerous tissue and therefore becomes slightly radioactive. This radioactivity can then be detected by scanning the axilla or the entire patient. However PET scanning cannot detect small amounts of cancer in the lymph node (anything <5 mm).

However, a better question might be - Why do we need to know the status of the axillary lymph nodes in breast cancer? Removing the lymph nodes in breast cancer has always been thought of as prognostic (helping determine how well a patient will do and how much chemotherapy to give) but not therapeutic (helping to improve survival). We are now able to determine the prognosis of the patient by looking at the biology of their cancer with newer advanced pathologic tests such as MammaPrint, OncotypeDX, MammaStrat and others. I believe we will stop doing sentinel node biopsy and axillary surgery in general (outside of removing bulky lymph nodes) in the very near future. There is nothing better to assess axillary lymph node status than sentinel lymph node biopsy. PET scanning has been tried. This involves radioactive glucose injected into the patient's venous system. This radioactive glucose is taken up by cancer more readily than non-cancerous tissue and therefore becomes slightly radioactive. This radioactivity can then be detected by scanning the axilla or the entire patient. However PET scanning cannot detect small amounts of cancer in the lymph node (anything <5 mm).

However, a better question might be - Why do we need to know the status of the axillary lymph nodes in breast cancer? Removing the lymph nodes in breast cancer has always been thought of as prognostic (helping determine how well a patient will do and how much chemotherapy to give) but not therapeutic (helping to improve survival). We are now able to determine the prognosis of the patient by looking at the biology of their cancer with newer advanced pathologic tests such as MammaPrint, OncotypeDX, MammaStrat and others. I believe we will stop doing sentinel node biopsy and axillary surgery in general (outside of removing bulky lymph nodes) in the very near future.