From the Guidelines
Lymph nodes are removed to diagnose and treat cancer, with the primary goal of preventing the spread of the disease and improving patient outcomes in terms of morbidity, mortality, and quality of life. The decision to remove lymph nodes is based on various factors, including the type and stage of cancer, the presence of cancer cells in the lymph nodes, and the patient's overall health. In the context of melanoma, for example, sentinel lymph node biopsy (SLN biopsy) is a diagnostic procedure that helps determine if cancer has spread to the lymph nodes 1. According to the American Society of Clinical Oncology and Society of Surgical Oncology clinical practice guideline update, SLN biopsy has diagnostic and therapeutic effects in patients with a low tumor burden in a positive SLN 1. However, the decision to perform a complete lymph node dissection (CLND) versus close observation should be based on a discussion of the risks and benefits, weighing morbidity and potential risk of complications with the advantages of improved regional disease-free survival and more accurate prognostic assessment of the nodal basin 1. Recent studies, such as the MSLT-II and DeCOG trials, have shown that CLND for SN-positive patients does not impact survival compared to nodal observation with periodic ultrasound of the SN-positive basin 1. Therefore, the current recommendation is to consider close observation with periodic ultrasound as a viable alternative to CLND for patients with a positive SLN biopsy, taking into account the patient's individual risk factors and preferences. Key considerations in the decision-making process include the tumor burden, the presence of high-risk clinicopathological factors, and the potential risks and benefits of each approach 1. Ultimately, the goal of lymph node removal is to improve patient outcomes by preventing the spread of cancer and minimizing treatment-related morbidity.
From the Research
Reasons for Lymph Node Removal
- Lymph nodes are removed to assess the spread of cancer, as the presence of cancer cells in the lymph nodes is a major prognostic factor in early-stage breast cancer 2
- The removal of lymph nodes, such as through axillary lymph node dissection (ALND), can provide information on the extent of cancer spread, but it may result in complications like lymphedema, nerve injury, and shoulder dysfunction 2
- Sentinel lymph node biopsy (SLNB) is a less invasive alternative to ALND, which can reduce the risk of complications while still providing accurate information on cancer spread 2, 3
- The removal of lymph nodes can also be necessary for staging and treatment of other types of cancer, such as melanoma, where sentinel lymph node biopsy is recommended for tumors with a thickness of ≥0.8 mm or any ulcerated melanoma 4
Complications of Lymph Node Removal
- Lymphedema is a potential complication of lymph node removal, with a higher incidence in patients who undergo excision of more than 5 lymph nodes 5
- The risk of lymphedema can be reduced by using less invasive methods like SLNB, which can spare patients from more extensive axillary lymph node dissection 2, 5
Alternatives to Lymph Node Removal
- Imaging techniques, such as those used in nuclear medicine, can be used to detect lymph node metastases, but they may not be accurate enough for early-stage cancer 6
- Sentinel lymph node biopsy is a highly reliable method for screening axillary nodes and identifying metastatic disease in regional lymph nodes, making it a preferred alternative to lymph node removal in many cases 2, 6