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The British half of the sentinel node question, and the one that measured what patients actually feel. A year after surgery, arm swelling had fallen from about one woman in eight to one in twenty, and numbness from about one in three to one in nine.
ALMANAC randomised 1,031 patients with clinically node-negative invasive breast cancer to sentinel lymph node biopsy (515) or to standard axillary treatment (516) between November 1999 and October 2003. Unlike NSABP B-32 it made arm and shoulder morbidity and quality of life the primary outcomes, on the reasoning that the survival question was being answered elsewhere and the morbidity question was the one patients were asking.
At twelve months the relative risk of any lymphoedema in the sentinel node arm was 0.37 (95 percent confidence interval 0.23 to 0.60), an absolute fall from 13 to 5 percent, and the relative risk of sensory loss was 0.37 (0.27 to 0.50), from 31 to 11 percent. Drain use, length of stay and time to resumption of normal activities were all significantly lower (p<0.001 for each), and axillary operating time fell (p=0.055). Patient-recorded quality of life and arm function were better throughout (p at or below 0.003), with no increase in anxiety.
ALMANAC is why the sentinel node case is usually made in terms of harm avoided rather than benefit gained. The cancer outcome is the same; what changes is whether a woman can lift her arm, feel her upper inner arm, and avoid a sleeve for the rest of her life.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
1,031 randomised.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Any lymphoedema at 12 monthsprimary | Sentinel lymph node biopsy | 515 | 5% | - | - | link |
| Standard axillary treatment | 516 | 13% | ||||
| Sensory loss at 12 monthsprimary | Sentinel lymph node biopsy | 515 | 11% | - | - | link |
| Standard axillary treatment | 516 | 31% |
Shares NSABP B-32, Lymphoedema after breast cancer treatment, Doing less to the armpit, Sentinel node biopsy.
Shares NSABP B-32, Lymphoedema after breast cancer treatment, Doing less to the armpit, Sentinel node biopsy.
Shares Lymphoedema after breast cancer treatment, Doing less to the armpit, Sentinel node biopsy, Lymphadenectomy (lymph node dissection).
Shares Lymphoedema after breast cancer treatment, Doing less to the armpit, Sentinel node biopsy, Lymphadenectomy (lymph node dissection).
Shares NSABP B-32, Lymphoedema after breast cancer treatment, Doing less to the armpit, Sentinel node biopsy.
Shares Lymphoedema after breast cancer treatment, Doing less to the armpit, Sentinel node biopsy, Lymphadenectomy (lymph node dissection).
Shares Lymphoedema after breast cancer treatment, Doing less to the armpit, Sentinel node biopsy, Sentinel lymph node biopsy.
Shares Doing less to the armpit, Sentinel node biopsy, Lymphadenectomy (lymph node dissection), Sentinel lymph node biopsy.