A few studies have investigated ALND
levels as a possible risk factor; however, these have not been sufficiently evaluated in studies that have focused on breast cancer-induced lymphedema.
While Veridex does not purport to resolve the ITC/micrometastasis issue, the company offers an alternative method to determine prognosis without the morbidity of ALND
6,7) In light of these vagaries in practice patterns nationally, the need for ALND
in patients with ITCs has become controversial.
This study has demonstrated a significant reduction in the incidence of lymphoedema at one year postoperatively, further supporting this approach to physiotherapy following ALND
7) As a result, it has been recommended that each surgeon (and the team involved) perform both a SLNB and an ALND
on a number of cases before relying solely on a SLNB.
To better distinguish those patients who need an ALND
from those who don't, patients now can undergo a less invasive technique called sentinel lymph node biopsy (SLNB).
Women who undergo ALND
have a 10-20% chance of developing severe arm swelling.
Patients with SLN metastases identified by SLND were randomized to undergo ALND
or no further axillary treatment.
can also provide additional prognostic staging information which can alter or influence adjuvant treatment options.
Beginning in July 1999, patients undergoing planned completion ALND
were injected via the intradermal technique, which involved injection with 0.
This research is particularly intriguing as after 90 days there is evidence that when ON-Q was used there was a reduction in some of the chronic morbidities normally seen after breast cancer surgery, a finding we hope will prove to be the case more and more with ALND
and other surgeries.
Currently, completion ALND
is recommended but this involves a second procedure if routine H&E pathology is used to assess the SLN.