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Sentinel node biopsy = less lymphedema, better QOL (ALMANAC)

General

Clinical Question:
Is sentinel lymph node biopsy preferred over standard axillary node dissection in patients undergoing surgery for breast cancer?

Bottom Line:
Compared with standard axillary node dissection, sentinel lymph node biopsy is associated with less lymphedema and better quality of life in patients undergoing surgery for early stage breast cancer that clinically appears to be node-negative. (LOE = 2b)

Reference:
Mansel RE, Fallowfield L, Kissin M, et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial. J Natl Cancer Inst 2006;98:599-609.  [PMID:16670385]

Study Design:
Randomized controlled trial (nonblinded)

Allocation:
Concealed

Setting:
Inpatient (any location) with outpatient follow-up

Synopsis:
In this multicenter study, women younger than 80 years scheduled to have a wide local excision or mastectomy for clinically node-negative invasive breast cancer were randomly assigned to standard axillary node dissection (n=496) or sentinel lymph node biopsy (n=495). Before being allowed to participate in the trial, the surgeons had to pass muster by performing at least 40 sentinel lymph node biopsies that were followed by more invasive axillary node dissection. If the surgeon identified the sentinel lymph node at least 90% of the time, he or she could participate. The main outcomes -- lymphedema and quality of life -- were assessed via intention to treat. At the end of 1 year, 2.1% of the standard treatment patients reported moderate to severe lymphedema compared with 0.8% of those treated with sentinel node biopsy (number needed to treat = 80). Participants undergoing sentinel node biopsy reported better quality of life, as measured by the Trial Outcome Index of the Functional Assessment of Cancer Therapy--Breast (FACT-B), a breast cancer-specific quality of life measure. At the end of 1 year, the researchers had complete follow-up data on 82% of the patients, which could affect the overall results.

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Citation

Slawson, David C., et al., editors. "Sentinel Node Biopsy = Less Lymphedema, Better QOL (ALMANAC)." EE+ POEM Archive, John Wiley & Sons, 2019. Evidence Central, evidence.unboundmedicine.com/evidence/view/infoPOEMs/426622/all/Sentinel_node_biopsy_=_less_lymphedema__better_QOL__ALMANAC_.
Sentinel node biopsy = less lymphedema, better QOL (ALMANAC). In: Slawson DC, Shaughnessy AF, Ebell MH, et al, eds. EE+ POEM Archive. John Wiley & Sons; 2019. https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426622/all/Sentinel_node_biopsy_=_less_lymphedema__better_QOL__ALMANAC_. Accessed July 17, 2019.
Sentinel node biopsy = less lymphedema, better QOL (ALMANAC). (2019). In Slawson, D. C., Shaughnessy, A. F., Ebell, M. H., & Barry, H. (Eds.), EE+ POEM Archive. Available from https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426622/all/Sentinel_node_biopsy_=_less_lymphedema__better_QOL__ALMANAC_
Sentinel Node Biopsy = Less Lymphedema, Better QOL (ALMANAC) [Internet]. In: Slawson DC, Shaughnessy AF, Ebell MH, Barry H, editors. EE+ POEM Archive. John Wiley & Sons; 2019. [cited 2019 July 17]. Available from: https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426622/all/Sentinel_node_biopsy_=_less_lymphedema__better_QOL__ALMANAC_.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Sentinel node biopsy = less lymphedema, better QOL (ALMANAC) ID - 426622 ED - Slawson,David C, ED - Shaughnessy,Allen F, ED - Ebell,Mark H, ED - Barry,Henry, BT - EE+ POEM Archive UR - https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426622/all/Sentinel_node_biopsy_=_less_lymphedema__better_QOL__ALMANAC_ PB - John Wiley & Sons DB - Evidence Central DP - Unbound Medicine ER -