Prevalence of Lymphedema in Women With Breast Cancer 5 Years After Sentinel Lymph Node Biopsy or Axillary Dissection: Objective Measurements

McLaughlin, Sarah A.; Wright, Mary Jo; Morris, Katherine T.; Giron, Gianpiero; Sampson, Michelle; Brockway, Julia P.; Hurley, Karen; Riedel, Elyn; Zee, Kimberly J. Van

doi:10.1200/jco.2008.16.3725

Cited by 535 publications

(378 citation statements)

References 23 publications

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“…The incidence of chronic, potentially disabling complications such as lymphedema and paraesthesia is of greater concern to both patients and surgeons, and their incidence at 6 months post-operatively was also evaluated. Previous studies have reported that lymphoedema of the upper extremity occurs in approximately 5-8% of patients post-SNB [19][20][21] and 10-20% of patients post-ALND [22]. In the current analysis, the risk of upper limb lymphoedema and paraesthesia at 6 months was significantly diminished in those undergoing SNB (4.8 vs. 13.3%, SNB vs. ALND).…”

Section: Discussionmentioning

confidence: 41%

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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Section: Discussionmentioning

confidence: 41%

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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“…12 Using the same definition, in our own practice, we have observed lymphedema at a median follow-up of 5 years in 5% of 600 women who underwent SLN biopsy alone (vs 16% of those who underwent ALND). 13 Although these and a growing number of other studies relate the risk of post-SLN biopsy lymphedema with obesity, body mass index, age, infection, and other variables, none to our knowledge have considered surgeon bias. Do we remove more lymph nodes in those patients for whom we expect an increased risk of lymph node involvement?…”

Section: Resultsmentioning

confidence: 99%

Number of lymph nodes removed in sentinel lymph node‐negative breast cancer patients is significantly related to patient age and tumor size

Port

Patil

Stempel

et al. 2010

Cancer

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BACKGROUND: Sentinel lymph node (SLN) biopsy has been well-established for axillary lymph node staging for patients with breast cancer. For lymph node-negative patients, planned ''backup'' axillary lymph node dissection (ALND) is rarely indicated. Among patients with negative SLNs, the authors observed variation by tumor size and patient age in the total number of lymph nodes removed (SLNs plus non-SLNs). They hypothesized that this variation is an unrecognized source of bias for studies examining the morbidity of SLN biopsy. METHODS: Retrospective review of this institution's SLN database identified 4103 SLN biopsy procedures between 1997 and 2004 in which SLN biopsy was performed for prophylactic mastectomy, ductal carcinoma in situ, or T1 to T2 invasive cancers, and the SLNs were benign. RESULTS: The mean number of SLNs, non-SLNs, and total lymph nodes for all tumor sizes was 2.8, 1.5, and 4.3, respectively, and increased with tumor size (more lymph nodes were removed for T2 than for T1 tumors: 6.3 vs 4.3; P < .0001). This trend remained significant even in the later years of these investigators' experience with SLN biopsy, and was observed for 5 of 9 (56%) surgeons. More total lymph nodes were also removed in patients aged 50 years than in those aged >50 years (4.6 lymph nodes vs 4.2 lymph nodes; P ¼ .006). In approximately 8% of patients (322 of 4103 patients), 10 lymph nodes were removed. CONCLUSIONS: The morbidity of SLN biopsy is less than that of ALND, but for pN0 patients, the total number of lymph nodes removed increased with tumor size and younger patient age. This variation is a previously unrecognized source of bias for studies that examine the morbidity of SLN biopsy. Cancer 2010;116:1987-91.

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“…Only 1 study in this group used objective measurement methods (circumference), whereas the remainder assessed lymphedema subjectively. The length of follow-up ranged from 9 to 115 months, and the median quality score for these studies was 5 (range, [3][4][5][6][7][8][9].…”

Section: Type Of Malignancymentioning

confidence: 99%

“…However, secondary lymphedema has been shown to occur after even simple operations, such as wide local excision or sentinel lymph node biopsy. 8 Acknowledging the lack of consistent, comprehensive lymphedema incidence estimates outside of the field of breast cancer, the aim of this study is to review the available body of oncology literature assessing post-treatment lymphedema in patients with other types of malignancies to broadly examine the incidence of lymphedema in the wider population of cancer survivors. In addition, we sought to identify risk factors associated with the development of lymphedema, to inform healthcare providers and promote awareness of this widespread and debilitating condition in the oncology community.…”

mentioning

confidence: 99%

Lymphedema beyond breast cancer

Cormier

Askew

Mungovan

et al. 2010

Cancer

387

162

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BACKGROUND: Secondary lymphedema is a debilitating, chronic, progressive condition that commonly occurs after the treatment of breast cancer. The purpose of the current study was to perform a systematic review and meta-analysis of the oncology-related literature excluding breast cancer to derive estimates of lymphedema incidence and to identify potential risk factors among various malignancies. METHODS: The authors systematically reviewed 3 major medical indices (MEDLINE, Cochrane Library databases, and Scopus) to identify studies that included a prospective assessment of lymphedema after cancer treatment. Studies were categorized according to malignancy, and data included treatment, complications, lymphedema measurement criteria, lymphedema incidence, and followup interval. A quality assessment of individual studies was performed using established criteria for systematic reviews. Bayesian meta-analytic techniques were applied to derive summary estimates when sufficient data were available. RESULTS: A total of 47 studies (7779 cancer survivors) met inclusion criteria: melanoma (n ¼ 15), gynecologic malignancies (n ¼ 22), genitourinary cancers (n ¼ 8), head/neck cancers (n ¼ 1), and sarcomas (n ¼ 1). The overall incidence of lymphedema was 15.5% and varied by malignancy (P < .001): melanoma, 16% (upper extremity, 5%; lower extremity, 28%); gynecologic, 20%; genitourinary, 10%; head/neck, 4%; and sarcoma, 30%. Increased lymphedema risk was also noted for patients undergoing pelvic dissections (22%) and radiation therapy (31%). Objective measurement methods and longer follow-up were both associated with increased lymphedema incidence. CONCLUSIONS: Lymphedema is a common condition affecting cancer survivors with various malignancies. The incidence of lymphedema is related to the type and extent of treatment, anatomic location, heterogeneity of assessment methods, and length of follow-up. Cancer 2010;116:5138-49.

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Prevalence of Lymphedema in Women With Breast Cancer 5 Years After Sentinel Lymph Node Biopsy or Axillary Dissection: Objective Measurements

Cited by 535 publications

References 23 publications

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

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

Number of lymph nodes removed in sentinel lymph node‐negative breast cancer patients is significantly related to patient age and tumor size

Lymphedema beyond breast cancer

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