Morbidity in Breast Cancer Patients with Sentinel Node Metastases Undergoing Delayed Axillary Lymph Node Dissection (ALND) Compared with Immediate ALND

Goyal, Amit; Newcombe, Robert G.; Chhabra, Alok; Mansel, Robert Edward

doi:10.1245/s10434-007-9593-3

Cited by 81 publications

(46 citation statements)

References 7 publications

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“…As outlined above, the plateau in upper limb volume 2 years after surgery suggests that estimates of lymphedema rates at 2 years may be an accurate estimate of the long-term rates of lymphedema after RAC. This is consistent with the results of a long-term cohort study in which 77% of patients with lymphedema developed it within 3 years after RAC [12]. Patients can also be advised that the risk of a significant increase in upper limb volume developing after axillary clearance is about 1 in 6.…”

Section: Discussionsupporting

confidence: 88%

Sentinel Lymph Node Based Management or Routine Axillary Clearance? Three-year Outcomes of the RACS Sentinel Node Biopsy Versus Axillary Clearance (SNAC) 1 Trial

et al. 2014

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SynopsisWe compared sentinel-lymph-node based management (SNBM) versus routine axillary clearance (RAC) for women with early breast cancer in a large scale randomised trial. The benefits of SNBM over RAC persisted after 3 years of followup. SNAC 3 years6-May-14 3 Abstract PurposeWe sought to determine whether the benefits of sentinel-node-based management (SNBM) over routine axillary clearance (RAC) at 1 year persisted to 3 years of follow-up.Methods 1088 women with clinically node negative breast cancer were randomly assigned to SNBM versus RAC. Upper limb volume, symptoms and function were assessed at 1, 6, 12, 24 and 36 months after surgery objectively with upper limb measurements by clinicians, and subjectively by patients' using validated self-rating scales. ResultsUpper limb volume increased in both groups over the first 2 years and differed between the two groups all time points beyond 1 month (P<0.02), but then plateaued.Upper limb swelling was no worse in women who had axillary clearance as two-stage procedure than in women assigned RAC as a one-stage procedure. Upper limb volume had increased 15% or more in 6.0% at 6 months and 17.6% at 3 years in those assigned RAC versus 4.2% and 11.9% in those assigned SNBM. Reductions in upper limb movement were also greater with RAC than SNBM over 6 months, but improved and were similar in the two groups from 1 to 3 years. Subjective ratings of upper limb swelling, symptoms, dysfunction, and disability over 3 years were worse in the RAC group. Upper limb swelling at 3 years was rated severe by few women (1.1%), but moderate by 9.4% in the RAC group and 2.5% in the SNBM group (P<0.001). ConclusionsThe benefits of SNBM over RAC persist 3 years after surgery.

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Section: Discussionsupporting

confidence: 88%

Sentinel Lymph Node Based Management or Routine Axillary Clearance? Three-year Outcomes of the RACS Sentinel Node Biopsy Versus Axillary Clearance (SNAC) 1 Trial

et al. 2014

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“…This is in keeping with work by Giuliano et al who demonstrated an overall complication rate of 3% after SNB compared with 35% post-ALND [23]. Although it is possible that a SNB followed by an axillary dissection might have greater morbidity than an axillary dissection alone, the ALMANAC trial showed no significant difference in post-operative morbidity between SNB (with delayed ALND) and the group who underwent ALND alone [24]. In addition to documented improvements in morbidity, improved psychological well being has been observed in patients who undergo SNB relative to ALND [9].…”

Section: Discussionsupporting

confidence: 87%

Outcome of axillary staging in early breast cancer: a meta-analysis

Kell

Burke

Barry

et al. 2010

Breast Cancer Res Treat

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Axillary lymph node dissection (ALND) is associated with significant morbidity, whilst sentinel node biopsy (SNB) has the potential to minimize complications in the management of breast cancer. The aim of this study was to systematically appraise the outcome of SNB when compared to ALND. A comprehensive search for published trials examining outcomes after SNB for breast cancer was performed using medline and cross-referencing available data. Each study was reviewed and data extracted. Primary outcomes were nodal positivity and surgery-related morbidity. A total of 9,608 patients were identified from trials comparing ALND and SNB. The overall rate of axillary lymph node positivity for those with no clinically palpable nodes was 28.8% for ALND and 27.6% for SNB (OR = 1.00, 95% CI = 0.86-1.17, P = 0.956), though there was a trend for superior detection of metastatic disease with SNB when this was compared with ALND alone (OR = 1.22, 95% CI = 0.95-1.57, P = 0.122). Patients who undergo SNB are significantly less likely to suffer post-operative morbidity relative to ALND: risk of infection (OR = 0.58, 95% CI = 0.42-0.80, P = 0.0011), seroma (OR = 0.40, 95% CI = 0.31-0.51, P = 0.0071), arm swelling (OR = 0.30, 95% CI = 0.14-0.66, P = 0.0028) and numbness (OR = 0.25, 95% CI = 0.1-0.59, P = 0.0018).SNB is at least equivalent to ALND in detecting metastatic disease in the axilla. SNB is the optimum approach in terms of morbidity for the assessment of axillary metastasis in clinically node negative breast cancer.

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“…Evaluation of arm and breast morbidity included the rates of lymphedema, pain, neuropathy, and reduced range of motion in the ipsilateral arm. At 6-12 mo after surgery, all these outcomes were less frequent in SLNB patients than in ALND patients (34,(40)(41)(42)(43)(44)(45). Table 1 summarizes the framework and results of the most important randomized controlled trials comparing SLNB and SLNB 1 ALND SLNB in the management of breast cancer.…”

Section: Cancer Indications Breast Cancermentioning

confidence: 99%

Lymphoscintigraphy and Sentinel Nodes

2015

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Learning Objectives: On successful completion of this activity, participants should be able to describe (1) generic fundamentals of lymphoscintigraphy procedures of sentinel lymph node biopsy (SLNB) protocols; (2) specific injection and imaging components of SLNB protocols used in the management of patients with breast cancer, melanoma, and head and neck malignancies; and (3) specific indications of breast cancer, melanoma, and head and neck malignancies that suggest inclusion of a SLNB in the management of a patient.Financial Disclosure: The authors of this article have indicated no relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, SAM, and other credit types, participants can access this activity through the SNMMI website (http://www.snmmilearningcenter.org) through June 2018.It has been validated that sentinel lymph node biopsy (SLNB) shows whether a patient's breast cancer or melanoma has spread to regional lymph nodes. As a result, management of patients with these cancers has been revolutionized. SLNB has replaced axillary lymph node dissection (ALND) as the staging modality of choice for early breast cancer and has replaced complete lymph node dissection as the staging modality of choice for melanoma in patients whose SLNBs indicate no metastases. Recently concluded multicenter, randomized trials for breast cancer with 5-to 10-y outcome data have shown no significant differences in disease-free survival rates or overall survival rates between SLNB and ALND groups but have shown significantly lower morbidity with SLNB than with ALND. The lowest false-negative rates (5.5%-6.7%) were seen in studies that used preoperative lymphoscintigraphy and dual mapping during surgery. To assess the survival impact of SLNB in melanoma, the Multicenter Selective Lymphadenectomy Trial I was performed. Melanoma-specific survival rates were not different between subjects randomized to SLNB with lymphadenectomy for nodal metastasis on biopsy and subjects randomized to observation with lymphadenectomy for nodal relapse. However, the 10-y disease-free survival rates were better for the SLNB group than for the observation group, specifically among patients with intermediate-thickness melanomas or thick melanomas.

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Morbidity in Breast Cancer Patients with Sentinel Node Metastases Undergoing Delayed Axillary Lymph Node Dissection (ALND) Compared with Immediate ALND

Abstract: A two-stage axillary node dissection procedure in patients with SLN metastases has similar arm morbidity to one-stage ALND. The second surgery is associated with increased axillary operative time and total hospital stay.

Cited by 81 publications

References 7 publications

Sentinel Lymph Node Based Management or Routine Axillary Clearance? Three-year Outcomes of the RACS Sentinel Node Biopsy Versus Axillary Clearance (SNAC) 1 Trial

Sentinel Lymph Node Based Management or Routine Axillary Clearance? Three-year Outcomes of the RACS Sentinel Node Biopsy Versus Axillary Clearance (SNAC) 1 Trial

Outcome of axillary staging in early breast cancer: a meta-analysis

Lymphoscintigraphy and Sentinel Nodes

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