19 November 2015
Should axillary lymph nodes be removed or not in breast cancer patients? (press release Maastricht UMC+)

MRI with contrast appears to provide good diagnosis

At Maastricht UMC+, research is being carried out to determine whether or not axillary lymph nodes should always be removed in breast cancer patients. Doctoral research by surgical trainee Robert-Jan Schipper looked at whether imaging techniques can reliably rule out the presence of malignant cells in the lymph nodes.

Breast cancer is the most common type of cancer in women worldwide. In the Netherlands, 14,000 women are diagnosed with breast cancer every year. The first choice of treatment for breast cancer is usually to remove the breast tumour, and also one or more lymph nodes from the axilla. If necessary, the treatment is supplemented with chemotherapy, immunotherapy, former therapy and/or radiation therapy. Each part of the treatment can result in lifelong side-effects. Is therefore important that the treatment does not involve more elements than is absolutely necessary, and that the treatments which contribute towards recovery and those which do not are determined beforehand. 

Sentinel Node

A procedure known as the Sentinel Node procedure is often carried out during breast cancer surgery. This involves removing the first axillary lymph node that receives lymph fluid from the breast tumour. This node is also the one to which any secondary cancer cells spread from the breast and is therefore known as the Sentinel Node (also sometimes called the Watch-Guard Node). In retrospect, however, most of these nodes do not contain malignant cells. Although the operation is a minor one, it can nevertheless result in fluid accumulation in the arm, nerve damage and reduced shoulder function. “Wouldn’t it be wonderful if, prior to surgery and without using invasive techniques, we could determine whether or not the axillary nodes need to be removed, and in this way reduce complications and discomfort ?”, says Schipper.

Research

The idea of providing maximum treatment whilst minimising the side effects was the key focus of the PhD candidate’s research. Various imaging techniques were examined during the search for a reliable technique with which to rule out the presence of malignant cells in the axillary lymph nodes. The results of this research may mean that future decisions about whether or not to remove axillary lymph nodes can be made with greater confidence.

MRI of the armpit using contrast medium

The pilot survey, which was carried out on 10 women, showed that a contrast-enhanced MRI scan of the armpit is almost equally reliable as postsurgical pathological examination of the excised lymph nodes. These promising results have since been further examined in a follow-up study. If the results of this follow-up study are as good as those from the pilot study, the contrast-enhanced MRI will be able to replace the standard examination methods used at present, namely ultrasound and the Sentinel Node procedure. Schipper: ‘This is the first time that the use of contrast-enhanced MRI in breast cancer patients has been examined. The research group is currently still too small, but the results of the study provide sufficient reason to examine this in a larger group in order to obtain more robust evidence.’  

On Friday 13 November, Robert-Jan Schipper was awarded a PhD from the university of Maastricht for his thesis entitled Exploring innovative nodal imaging and treatment strategies in breast cancer.