A study published in the Oct. 2 issue of JAMA shows that a more conservative intraoperative lymph node dissection for breast cancer is less harmful to patients and often has outcomes comparable to radical surgery. Current treatment guidelines recommend a complete axillary lymph node dissection: if a patient has a positive biopsy of an anterior lymph node, all 20-30 lymph nodes will be removed. A positive biopsy of an anterior lymph node indicates that the tumor has metastasized and allows assessment of the tumor’s grade. Axillary lymph node clusters are located at the edge of the pectoral muscle, deep in the axilla, and under the neck. The study was conducted by researchers at the University of Texas Southwestern Medical Center and the Harold C. Simmons Cancer Research Center. To assess the effectiveness of treatment guidelines, study first author Roshni Rao and other researchers reviewed the prognosis of breast cancer patients treated with various procedures, ranging from removal of a single lymph node to prevent breast cancer from spreading to removal of a network of lymph nodes that spanned the entire axilla. Rao et al. compared the risk-benefit of anterior lymph node biopsy with radical axillary lymph node dissection. They also compared the efficacy of nonsurgical treatment options (i.e., combined with radiation therapy) in female patients with breast cancer without definite lymph node involvement or with ultrasound-confirmed tumor spread to the axillary lymph nodes. Also, they used an online medical database to review recurrence rates, mortality, morbidity, and complications of various treatment options for axillary lymph node metastases. In total, they included more than 1,000 findings from 17 studies. For women who do not yet have suspicious lymph nodes and are treated with breast-conserving therapy, there is little evidence that performing a complete axillary lymph node dissection benefits patients more than performing only an anterior lymph node biopsy, according to the researchers. Breast-conserving therapy is defined as a partial mastectomy after a patient has received whole-breast radiation therapy. ”In the past, the status of the axillary lymph nodes was considered a key factor in the selection of treatment options,” according to Dr. Rao, “and we can get the same grading of breast cancer with an anterior lymph node biopsy alone, which also reduces patient morbidity and risk. Today, in the field of individualized medicine, chemotherapy regimens are often developed based on molecular tumor profiling, and there are other avenues of treatment to try besides “aggressive” treatments.” Rao noted that it is important to avoid axillary surgery if possible because it can cause a range of symptoms in the shoulder and arm, including lymphedema, severe pain or paresthesia, decreased range of motion and reduced range of motion; and axillary surgery often prolongs a patient’s hospital stay compared to an anterior lymph node biopsy.