2023-09-27 10:50:02
From an international study coordinated by the European Institute of Oncology in Milan comes a new breakthrough in minimally invasive breast cancer surgery. Patients with small tumors, ultra-early forms already candidates for conservative surgery, can now also avoid sentinel lymph node biopsy. This was announced by the IEO, communicating the results of the multicenter randomized Sound study (Sentinel Node vs Observation After Axillary Ultrasound), published in ‘Jama Oncology’.
In the trial – explain the Irccs founded by Umberto Veronesi – 1,463 women of all ages were recruited, with breast cancer with a maximum diameter of 2 centimeters and with a negative axillary ultrasound result, i.e. no metastases to the lymph nodes detected with ultrasound. The patients were randomly divided into two groups: half underwent a sentinel lymph node biopsy, the other half underwent no sampling or biopsy. After following their therapy – surgical and pharmacological or radiotherapy – the enrolled patients were evaluated for disease-free survival after 5 years and the data that emerged was clear: “There is no difference in the results of the treatment between those who had the biopsy of the sentinel lymph node and who does not. Therefore, patients with small tumors, who do not show metastatic lymph nodes on axillary ultrasound, can avoid any form of surgery in the axilla, even the sampling of the sentinel lymph node, with the certainty that their therapy will be equally effective”.
“Today we have reached and passed a new stage in the journey undertaken by my father Umberto to minimize the impact of breast cancer on women’s lives”, declares Paolo Veronesi, director of the Ieo Senology Program. “In this process – he underlines – surgery will increasingly reduce its invasiveness thanks to advanced imaging which, as we have demonstrated with Sound, allows accurate diagnoses”, and thanks “to genetics and genomics which also give us indications on prognosis and on the types of surgical interventions to be carried out. Perhaps one day we will say goodbye to the scalpel, but in the meantime our women can already now approach prevention with less and less fear: any tumor discovered in time can be truly treated in a minimally invasive way, as any other illness, without putting a stop to one’s life”.
“The sentinel lymph node technique – recalls Veronesi – is a milestone in the history of breast cancer and is today a standard technique to check whether tumor cells have already reached the axillary lymph nodes and therefore risk spreading to other organs giving rise to metastases Until a few years ago, even in small tumors that were candidates for conservative surgery, the sentinel lymph node was removed and analyzed to decide whether or not to remove the other lymph nodes as well. In this way we avoided emptying the axilla when not necessary, saving the patient possible consequences. For a few years, thanks to an American study, we have seen that it is useless to continue with axillary dissection even in the case of one or two positive sentinel lymph nodes”.
“Now we have taken a further step forward and have shown that sentinel lymph node biopsy in early tumors does not provide us with information that can modify post-operative therapies and improve recovery. Naturally – specifies the breast specialist – as long as the lymph nodes are studied as well as with the clinical examination also with an accurate ultrasound, to exclude the presence of gross metastatic involvement. The advantages for patients are evident, since surgery is even less invasive, and moreover the costs for our National Health Service decrease” .
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