Comparison of Lymphedema in Patients With Axillary Lymph Node Dissections to Those With Sentinel Lymph Node Biopsy Followed by Immediate and Delayed ALND

Kuwajerwala, Nafisa; Feczko, Claire; Dekhne, Nayana; Pettinga, Jane; Lucia, Victoria C.; Riutta, Justin; Vicini, Frank A.

doi:10.1097/coc.0b013e31823a4956

Cited by 14 publications

(8 citation statements)

References 10 publications

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“…The data from the current study identified ALND and RNI as two factors associated with the development of subclinical BCRL. These observations are consistent with previous studies that also found these factors (along with taxane chemotherapy and an elevated BMI) to be associated with the development of BCRL [ 4 , 7 – 9 , 19 – 22 , 25 , 26 ]. Additionally, a recent study from Turkey which utilized BIS and circumference arm measurements found BMI, number of nodes involved, and capsular invasion to be associated with BCRL, with the number of positive nodes also correlating with the L-Dex score [ 27 ].…”

Section: Discussionsupporting

confidence: 93%

Utilization of bioimpedance spectroscopy in the prevention of chronic breast cancer-related lymphedema

Kaufman¹,

Shah

Vicini

et al. 2017

Breast Cancer Res Treat

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Background This analysis was performed to assess the impact of early intervention following prospective surveillance using bioimpedance spectroscopy (BIS) to detect and manage breast cancer-related lymphedema (BCRL).MethodsFrom 8/2010 to 12/2016, 206 consecutive patients were evaluated with BIS. The protocol included pre-operative assessment with L-Dex as well as post-operative assessments at regular intervals. Patients with L-Dex scores >10 from baseline were considered to have subclinical BCRL and were treated with over-the-counter (OTC) compression sleeve for 4 weeks. High-risk patients were defined as undergoing axillary lymph node dissection (ALND), receiving regional nodal irradiation (RNI), or taxane chemotherapy. Chronic BCRL was defined as the need for complex decongestive physiotherapy (CDP).ResultsMedian follow-up was 25.9 months. Overall, 17% of patients had one high-risk feature, 8% two, and 7% had three. 9.8% of patients were diagnosed with subclinical BCRL with highest rates seen following ALND (23 vs. 7%, p = 0.01). Development of subclinical BCRL was associated with ALND and receipt of RNI. At last follow-up, no patients (0%) developed chronic, clinically detectable, BCRL. Subset analysis was performed of the 30 patients undergoing ALND. Median number of nodes removed was 18 and median number of positive nodes was 2. 77% received taxane chemotherapy, 62% axillary RT, and 48% had elevated BMI. Overall, 86% of patients had at least one additional high-risk feature, 70% at least two, and 23% had all three. Seven patients (23%) had abnormally elevated L-Dex scores at some point during follow-up. To date, none has required CDP.ConclusionsThe results of this study support prospective surveillance utilizing BIS initiated pre-operatively with subsequent post-operative follow-up measurements for the detection of subclinical BCRL. Intervention triggered by subclinical BCRL detection with an elevated L-Dex score was associated with no cases progressing to chronic, clinically detectable BCRL even in very high-risk patients.

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Section: Discussionsupporting

confidence: 93%

Utilization of bioimpedance spectroscopy in the prevention of chronic breast cancer-related lymphedema

Kaufman¹,

Shah

Vicini

et al. 2017

Breast Cancer Res Treat

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“…10 However, Kuwajerwala and colleagues found no statistically significant difference in the lymphoedema rate between immediate versus delayed ALND, although the rate of lymphoedema was higher in the delayed group (10.3% vs 14.3%, P > .05). 23 Ballal et al published our institution's results from 2008 to 2012, which also demonstrated no statistically significant difference in the lymphoedema rates between immediate versus delayed ALND (17.8% vs 8.6%). 19 In our current study, the results reflect our prior institution's results with no statistically significant difference in postoperative lymphoedema.…”

Section: Discussionmentioning

confidence: 62%

Breast cancer treatment‐related arm lymphoedema and morbidity: A 6‐year experience in an Australian tertiary breast centre

Huang

Toh

Hunt

et al. 2021

Asia-Pac J Clncl Oncology

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Aim: Recent surgical de-escalation of the axilla in breast cancer management has led to reduced number of immediate and delayed axillary lymph node dissections (ALND) after sentinel lymph node biopsies (SLNBs). We aim to assess the postoperative impact of SLNB versus immediate and delayed ALND on arm lymphoedema and morbidity.Methods: A retrospective analysis from a prospectively collected institutional database was performed reviewing the rates of lymphoedema and arm morbidity in terms of shoulder restriction and patient-reported functional deficit in women undergoing axillary surgery for breast cancer between 2013 and 2018. Results:In this 776 patient cohort (564 SLNBs, 192 immediate ALNDs and 20 delayed ALNDs), at 12 months after surgery, the results are as follows: lymphoedema rate: SLNB (4.62%), immediate ALND (19.51%), delayed ALND (15.00%); axillary cording rate: SLNB (3.08%), immediate ALND (10.65%), delayed ALND (5.00%); new functional deficit: SLNB (5.58%), immediate ALND (13.66%) and delayed ALND (20%); pain SLNB (14.02%), immediate ALND (15.97%), delayed ALND (17.65%); shoulder flexion/abduction restrictions: SLNB (8.14%/5.14%), immediate ALND (16.45%/15.79%) and delayed ALND (17.65%/20.00%). ALND was associated with increased risk of developing lymphoedema, shoulder dysfunction and development of more than one morbidity. No statistically significant difference in lymphoedema and morbidity outcome was observed between immediate and delayed ALND. Conclusion:Immediate and delayed ALND have comparable outcomes, but both are associated with increased postoperative arm lymphoedema and morbidity outcomes compared to SLNB alone. Preoperative appropriate selection of patients for axillary surgery treatment may improve lymphoedema outcomes in breast cancer patients.

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“…1,2 However, an SLNB is not only still invasive, it is also associated with several postoperative complications, such as lymphedema, sensory loss, and upper limb pain. 3,4 Furthermore, the incidence of SLN metastasis in clinical axillary LNnegative patients was reported to be 23.0-37.1%, [5][6][7][8] and approximately 70-80% of patients receive excessive invasive axillary surgery. If predictive factors of SLN metastasis could be identified, we might be able to select candidate patients for an SLNB.…”

Section: Introductionmentioning

confidence: 99%

Predictive Factors Among Clinicopathological Characteristics for Sentinel Lymph Node Metastasis in T1-T2 Breast Cancer

Minami

Sakimura

Irie

et al. 2021

CMAR

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Comparison of Lymphedema in Patients With Axillary Lymph Node Dissections to Those With Sentinel Lymph Node Biopsy Followed by Immediate and Delayed ALND

Cited by 14 publications

References 10 publications

Utilization of bioimpedance spectroscopy in the prevention of chronic breast cancer-related lymphedema

Utilization of bioimpedance spectroscopy in the prevention of chronic breast cancer-related lymphedema

Breast cancer treatment‐related arm lymphoedema and morbidity: A 6‐year experience in an Australian tertiary breast centre

Predictive Factors Among Clinicopathological Characteristics for Sentinel Lymph Node Metastasis in T1-T2 Breast Cancer

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