Sentinel lymph node biopsy at the time of mastectomy does not increase the risk of lymphedema: implications for prophylactic surgery

Miller, Cynthia L.; Specht, Michelle C.; Skolny, Melissa N.; Jammallo, Lauren S.; Horick, Nora; O’Toole, Jean; Coopey, Suzanne B.; Hughes, Kevin S.; Gadd, Michele A.; Smith, Barbara L.; Taghian, Alphonse G.

doi:10.1007/s10549-012-2231-1

Cited by 25 publications

(18 citation statements)

References 42 publications

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“…Breast cancer-related lymphedema (BCRL) is affecting an increasing number of breast cancer patients with a longer survival rate for the patients [6]. Furthermore, patients who have undergone a mastectomy with axillary lymph node dissection (ALND) have a greater arm-volume and more commonly report www.e-arm.org symptoms of lymphedema, as compared to patients who have received a sentinel lymph node biopsy (SLNB) [5,7].…”

Section: Introductionmentioning

confidence: 99%

Long Term Effects of Complex Decongestive Therapy in Breast Cancer Patients with Arm Lymphedema after Axillary Dissection

Hwang

Kim

et al. 2013

PM&R

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Objective To investigate the long-term effects of complex decongestive therapy (CDT) on edema reduction in breast cancer-related lymphedema patients after axillary dissection, according to the initial volume of edema. Methods A retrospective review of 57 patients with unilateral arm after an axillary dissection for breast cancer was performed. The patients, treated with two weeks of CDT and self-administered home therapy, were followed for 24 months. Arm volume was serially measured by using an optoelectronic volumeter prior to and immediately after CDT; and there were follow-up visits at 3, 6, 12, and 24 months. Patients were divided into two groups according to the percent excess volume (PEV) prior to CDT: group 1, PEV<20% and group 2, PEV≥20%. Results In group 1, mean PEV before CDT was 11.4±5.0% and 14.1±10.6% at 24 months after CDT with no significant difference. At the end of CDT, PEV was 28.8±15.7% in group 2, which was significantly lower than the baseline (41.9±19.6%). The reduction of PEV was maintained for 24 months in group 2. Conclusion The long-term effects of CDT were well-maintained for 24 months, but there was a difference in progression of PEV between the two groups. The patients with more initial PEV showed significant volumereducing effects of CDT. In patients with less initial PEV, the severity of lymphedema did not progress to higher grades.

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Section: Introductionmentioning

confidence: 99%

Long Term Effects of Complex Decongestive Therapy in Breast Cancer Patients with Arm Lymphedema after Axillary Dissection

Hwang

Kim

et al. 2013

PM&R

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“…Pathologic review confirmed that the IHC-detected cells were morphologically consistent with the patient's contralateral breast carcinomaand there was no evidence of a traumatic origin (e.g., hemosiderin-laden macrophages, multinucleated giant cells, red blood cells, and/or lymphocytes) to suggest that their presence was the result of mechanical cell displacement Bunting et al(48) 5One of the positive lymph nodes was positive only by cytokeratin staining, three were micrometastases, and one was a macrometastasis. Two of the five patients with positive SLNs underwent completion axillary lymph node dissection, but no further lymph nodes were positive in either of those patients Miller et al(49) 1Occult invasive cancer had a micrometastasis to the SLNB Kuwajerwala et al…”

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confidence: 99%

Is Sentinel Lymph Node Biopsy Necessary in Patients Undergoing Prophylactic Mastectomy? A Systematic Review and Meta‐Analysis

Nagaraja¹,

Edirimanne²,

Eslick³

2016

Breast J

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The gain by performing sentinel lymph node biopsy (SLNB) during prophylactic mastectomy (PM) is debatable, and we performed a meta-analysis of existing literature to evaluate that the role of SLNB in subjects undergoing PM. A systematic search was conducted using MEDLINE, PubMed, EMBASE, Current Contents Connect, Cochrane library, Google Scholar, Science Direct, and Web of Science. The search identified 11 relevant articles reporting on patients who underwent SLNB at the time of PM. Data were abstracted from each study and used to calculate a pooled odds ratio (OR) and 95% confidence interval (95% CI). We included 14 studies comprising of 2,708 prophylactic mastectomies. Among 2,708 prophylactic mastectomies, the frequency of occult invasive cancer (51 cases) was 1.8% and the rate of positive SLNs (33 cases) was 1.2%. In 25 invasive cancers at the time of PM were found to have negative SLNs which avoided axillary lymph node dissection (ALND). In seven cases with positive SLNBs were found not to have invasive cancer at the time of PM and needed a subsequent ALND. Most of the patients with positive SLNs had locally advanced disease in the contralateral breast. SLNB may be suitable for patients with ipsilateral, locally advanced breast cancer and is not recommend for all patients undergoing PM.

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“…We have found no studies for comparison that are similar to ours that assess the lymphatic circulation in the immediate pre- and postsurgical period of patients submitted to SLNB. Patients submitted to prophylactic mastectomy on whom SLNB was performed showed no significant increase in the risk of developing lymphedema 61. Further studies using early and delayed postsurgery LS imaging should be conducted to identify the actual damage from SLNB to the lymphatic flow, especially when combined with more extensive breast surgery, including oncoplastic surgery.…”

Section: Discussionmentioning

confidence: 99%

Lymphoscintigraphy detecting alterations of upper limb lymphatic flow following early sentinel lymph node biopsy in breast cancer

Sarri

Tinóis

Vieira

et al. 2017

BCTT

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PurposeTo evaluate early variations in lymphatic circulation of the arm pre- and post-sentinel lymph node biopsy (SLNB) and conservative breast surgery by lymphoscintigraphy (LS).Patients and methodsBetween 2005 and 2012, 15 patients underwent LS before and after the SLNB (total=30 studies). The pre-SLNB study was considered the control. Early images within twenty minutes (dynamic and static images) and delayed images within ninety minutes of arms and armpits were acquired using a gamma camera. The LS images before and after the SLNB of each patient were paired and compared to each other, evaluating the site of lymphatic flow (in the early phase) and identifying the number of lymph nodes (in the late phase). These dynamic images were subjected to additional quantitative analysis to assess the lymphatic flow rate using the slope assessed by the angular coefficient of the radioactivity × time curves in areas of interest recorded in the axillary region. The variations of lymphatic flow and the number of lymph nodes in the post-SLNB LS compared to the pre-SLNB LS of each patient were classified as decreased, sustained or increased. The clinical variables analyzed included the period between performing the SLNB and the subsequent LS imaging, age, body mass index, number of removed lymph nodes, type of surgery and whether immediate oncoplastic surgery was performed.ResultsThe mean age was 54.53±9.03 years (36–73 years), the mean BMI was 27.16±4.16 kg/m2 (19.3–34.42), and the mean number of lymph nodes removed from each patient was 1.6±0.74 (1–3). There was significant difference in the time between surgery and the realization of LS (p=0.002; Mann–Whitney U test), but in an inverse relationship, the higher was the range, the smaller was the lymphatic flow, indicating a gradual reduction of lymphatic flow after surgery (Spearman’s p=0.498, with p=0.013).ConclusionUpper limb lymphatic flow gradually decreased after the SLNB and conservative breast surgery in this study, but these results are exploratory because of the small sample size. Further studies are needed to confirm and to investigate more in depth these findings.

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Sentinel lymph node biopsy at the time of mastectomy does not increase the risk of lymphedema: implications for prophylactic surgery

Cited by 25 publications

References 42 publications

Long Term Effects of Complex Decongestive Therapy in Breast Cancer Patients with Arm Lymphedema after Axillary Dissection

Long Term Effects of Complex Decongestive Therapy in Breast Cancer Patients with Arm Lymphedema after Axillary Dissection

Is Sentinel Lymph Node Biopsy Necessary in Patients Undergoing Prophylactic Mastectomy? A Systematic Review and Meta‐Analysis

Lymphoscintigraphy detecting alterations of upper limb lymphatic flow following early sentinel lymph node biopsy in breast cancer

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