Less can be more when removing lymph nodes.

• Position: Breast Cancer

A conservative approach to removing lymph nodes is associated with less harm for breast cancer patients and often yields the same results as more radical procedures, researchers at the University of Texas Southwestern Medical Center, Dallas, have found.

Roshni Rao, associate professor of surgery, and other investigators reviewed studies on patient outcomes of women who had received various forms of surgical treatment, ranging from removal of one lymph node to prevent the spread of breast cancer to removing the entire network of lymph nodes spanning the armpits.

Until recently, clinical practice guidelines advised complete axillary node dissection--removal of all 20-30 axillary nodes--if a woman's sentinel node biopsy was positive. The sentinel node generally is the first node to which cancer cells will spread from a primary tumor. A positive sentinel lymph node biopsy indicates the tumor has metastasized and can be used to determine the stage of the cancer. Axillary lymph nodes are distributed at the edge of the chest muscles and into the armpits and lower neck.

For women with no suspicious axillary nodes who undergo breast-conserving therapy, there is little evidence of...