Roberge is known nationally for her work in physical therapy for patients who have undergone axillary node dissection
and/or treatment for breast cancer.
For women with no suspicious axillary nodes who undergo breast-conserving therapy, there is little evidence of benefit in doing a complete axillary node dissection
compared with sentinel node biopsy alone, the reviewers report.
Arm edema was more common after lumpectomy plus axillary node dissection
than after lumpectomy alone.
In the American College of Surgeons Oncology Group's Z0011 trial, survival was nearly identical between women who underwent lumpectomy and sentinel node dissection alone, followed by adjuvant chemotherapy and tangential-field whole-breast irradiation, and women who underwent axillary node dissection
when sentinel node biopsy revealed limited metastasis, followed by the same chemotherapy and irradiation.
These subjects were randomly assigned to undergo standard axillary node dissection
(445 patients) or no axillary node dissection
(446 patients), followed by whole-breast tangential-field radiation (not third-field nodal irradiation) and whatever adjuvant systemic therapy their treating physicians deemed necessary.
Axillary node dissection
is slowly going out of favour for women with early breast cancer because of accumulating evidence that looking for metastases beyond sentinel lymph nodes does more harm than good.
Our findings lend support to axillary node dissection
for patients with micrometastasis or metastasis in their sentinel nodes.
The impact of prophylactic axillary node dissection
on breast cancer survival--a Bayesian meta-analysis.
Data from recent research studies suggest that the incidence of lymphoedema after axillary node dissection
and radiation therapy ranges from 10% to 31% (Shih 2009, ThomasMcLean 2008, Hayes 2008).
Women with circulatory and respiratory disabilities were significantly less likely than women without disabilities to receive axillary node dissection
and radiotherapy following BCS, which might reflect a variety of possibilities including patient preferences and substandard quality of care.
In 1987, a 39-year-old patient presenting with a 2-cm breast mass would likely have undergone an open biopsy in the operating room, followed by a thoughtful discussion of lumpectomy plus complete axillary node dissection
versus a modified radical mastectomy.
Clinically assessed problems with arm movement were reduced in sentinel node biopsy patients compared with axillary node dissection
patients at one month and three months after surgery, but the difference tended to disappear by six months.