Sentinel Lymph Node Biopsy in Small Breast Cancer: A Game-Changing Clinical Trial

In the world of breast cancer treatment, a clinical trial called the SOUND (Sentinel Node vs Observation After Axillary Ultra-Sound) trial has uncovered some exciting discoveries that could change how doctors approach early-stage breast cancer. This trial aimed to figure out if a specific kind of surgery, called sentinel lymph node biopsy (SLNB), is essential for patients with small breast cancer and negative results on a preoperative axillary ultrasound before surgery.

Clinical trial

The trial involved 1,463 women diagnosed with early-stage breast cancer. They all had tumors up to 2 centimeters in size and had negative results on a preoperative axillary ultrasound before their surgery. This trial, from February 2012 to June 2017 across several countries, challenged the common belief that SLNB is super important in understanding if cancer has spread to the lymph nodes.

The main question this trial tried to answer was whether skipping a certain kind of surgery called axillary surgery, was just as good as doing the SLNB surgery in terms of keeping patients free from the disease spreading for at least five years. The surprising discovery was that patients who skipped axillary surgery did just as well in terms of being free from the disease spreading compared to those who got the usual SLNB surgery. This finding suggests a possible change in how doctors might treat small breast cancers with negative axillary ultrasound results.

The trial included women of different ages and found that omitting axillary surgery didn't make things worse in terms of how long patients lived or how long they stayed free from the disease coming back. This discovery suggests that, for this specific group of patients with small breast tumors and negative axillary ultrasound results before surgery, they might not need axillary surgery as part of their treatment.

The trial also highlighted how important it is to do preoperative axillary ultrasonography before surgery to help doctors decide the best treatment. For patients who fit the specific criteria mentioned earlier and where not having certain information wouldn't change the treatment plan after surgery, this trial hints that axillary surgery might not be needed.

These findings could mean a big change. They suggest that some patients might not need the extra surgery of SLNB, which could lower the risks of complications and make life after surgery a bit easier. This change might help breast cancer patients by avoiding surgeries they might not need, which could reduce pain and the risk of certain complications like lymphedema.

However, it's important to remember that these findings might not be right for everyone with breast cancer. The trial's conclusions are only for patients with early-stage breast cancer, small tumors, and negative preoperative axillary ultrasound results.

Conclusion

The SOUND trial has brought forward a possibility: skipping axillary surgery might be a safe option for certain patients. This could change how doctors treat early-stage breast cancer, offering a more personalized and less invasive path for eligible patients.

Treatment decisions should always involve thorough talks between patients and their doctors. The trial's results offer hope for a more personalized and less invasive way of treating breast cancer, which could be a big step forward in giving better and more tailored care to patients.

__________