A trial comparing sentinel node biopsy with standard treatment of the armpit in breast cancer (The ALMANAC trial)

Cancer type:

Breast cancer




Phase 3

This trial looked at sentinel lymph node biopsy as a way of checking for cancer cells in the armpit after surgery for breast cancer.

After a diagnosis of breast cancer, it is important to check the lymph nodes Open a glossary item under your arm to see if they contain cancer cells. Usually doctors do this by removing some (or all) of the nodes and looking at them under a microscope. This is standard treatment Open a glossary item, but removing the lymph nodes can cause side effects such as swelling of the arm (lymphoedema).

Sometimes, doctors check just the first node under the arm that lymph fluid drains into from the breast. This is called sentinel lymph node biopsy. If this node is free of cancer cells, there may be very little risk that there are cancer cells in any of the other nodes.

The aim of this trial was to see if sentinel lymph node biopsy caused fewer arm problems, and improved the quality of life after surgery for early stage breast cancer Open a glossary item.

Summary of results

The trial found that people who had sentinel lymph node biopsy had fewer problems with their arm and shoulder after surgery than people who had more lymph nodes removed.

The trial recruited 1,031 patients. They had all been diagnosed with breast cancer and their doctors needed to check the lymph nodes under their arm for any cancer cells. Half the people taking part had sentinel node biopsy. The other half had more nodes removed, which was the standard treatment.

Analysis of results in 2006 found that lymphoedema, loss of sensation in the arm and reduced shoulder movement were more common in people who had the standard treatment Open a glossary item.

In a quality of life study, people who had sentinel lymph node biopsy rated their quality of life more highly, and were no more anxious than people who had standard treatment.

We have based this summary on information from the team who ran the trial. The information they sent us has been reviewed by independent specialists (peer reviewed Open a glossary item) and published in a medical journal. The figures we quote above were provided by the trial team. We have not analysed the data ourselves.

Recruitment start:

Recruitment end:

How to join a clinical trial

Please note: In order to join a trial you will need to discuss it with your doctor, unless otherwise specified.

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Chief Investigator

Professor Robert Mansel

Supported by

NIHR Clinical Research Network: Cancer
The Research and Development Office of Wales (NHS)

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Freephone 0808 800 4040

Last review date

CRUK internal database number:

Oracle 30

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Harriet wanted to try new treatments

Picture of Harriet

“I was keen to go on a clinical trial. I wanted to try new cancer treatments and hopefully help future generations.”

Last reviewed:

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