Sentinel lymph node versus axillary lymph node dissection for early-stage breast carcinoma

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Abstract
BACKGROUND The current study was performed to compare the value of sentinel lymph node dissection (SND) and axillary lymph node dissection (AND) in improving the utility‐adjusted survival for early‐stage breast carcinoma patients. METHODS A number needed to treat (NNT) analysis was used to compare SND with AND. In the NNT equation, 1/(SSND − SAND), S is the 5‐year utility‐adjusted survival. A literature review was performed to estimate 1) the prevalence of axillary lymph node disease for early‐stage breast carcinoma, 2) the sensitivity and specificity of SND and AND, 3) the 5‐year overall survival as a function of axillary lymph node involvement, 4) the risk of arm lymphedema as a function of the intervention performed, and 5) the utility correction (Uc; impairment of quality of life) for arm lymphedema. RESULTS The NNT method of analysis favored SND over nearly the entire range of parameters with a sign change to a negative value occurring only as Uc becomes very close to unity. This suggests the superiority of the SND approach. Only when there is minimal loss of utility does AND become favored and then only minimally. CONCLUSIONS Compared with AND, SND improves the utility‐adjusted survival in patients with early‐stage breast carcinoma. This finding is quite robust and was found to remain constant over a range of values for utility and lymph node prevalence. Cancer 2003;97:359–66. © 2003 American Cancer Society. DOI 10.1002/cncr.11081