Shoulder and arm morbidity in sentinel node-negative breast cancer patients: a systematic review

Abstract

The purpose of this study was to assess which shoulder and arm impairments are common in sentinel node-negative breast cancer patients and to describe the incidence and time course of these impairments. A systematic literature search was performed using different electronic databases until October 2013. Inclusion criteria were (1) research studies that included breast cancer patients surgically treated using the sentinel lymph node biopsy (SLNB) technique, (2) sentinel node-negative patients, and (3) studies that investigated morbidities of shoulder and/or arm. The exclusion criteria were (1) reviews or case studies, (2) patients who have had a SLNB followed by an axillary lymph node dissection (ALND), (3) results of ALND patients and SLNB patients were not described separately, and (4) no follow-up described. Thirty articles were included, representing 5,448 patients. Shoulder and arm impairments among sentinel node-negative patients are loss of mobility, loss of strength, pain, axillary web syndrome, and sensory disorders. Within the first month after SLNB, the morbidities with the highest incidence are decreased abduction (range 40.8-100 %), forward flexion of the shoulder (range 37-100 %), pain (range 3.4-56.6 %), and numbness (range 2-64 %). Morbidities with the highest incidence after 2 years are pain (range 5.6-51.1 %), numbness (range 5.1-51.1 %), loss of strength (range 0-57.7 %), decreased internal rotation (44.4 %), and decreased abduction (range 0-41.4 %). In conclusion, although the shoulder and arm impairments are less common after SLNB alone compared to ALND, they cannot be neglected. A considerable amount of patients still suffer from those impairments more than 2 years after surgery.

Feasibility of Using Low-Cost Motion Capture for Automated Screening of Shoulder Motion Limitation after Breast Cancer Surgery

“…We have observed that 15% of subjects showed clinically significant limitations in shoulder motion at the time of testing. Despite the heterogeneity of our sample, this is consistent with the time-course of arm morbidity reported in women with sentinel node-negative breast cancer [4]. …”

“…Shoulder motion impairments, including decreased range of motion (ROM), are common following surgery for breast cancer and can cause significant disability that can linger for years following treatment [2–4]. Symptoms that can limit shoulder motion, such as disuse, pain, numbness, and decreased strength, start to appear within days after cancer surgery and the percentage of patients that suffer from these symptoms tends to increase with time [4]. After the second week post-surgery more than 40% of patients showed a reduction in shoulder abduction of at least 10 degrees [5], and 37% of patients showed a reduction in shoulder flexion of at least 10 degrees [6].…”

A longitudinal analysis of chronic arm morbidity following breast cancer surgery

“…A deeper facet of the relationships between AM and negative affect was revealed when placed in the context of the time course of AM in the immediate years following treatment. Results from the repeated measures ANOVA showed that the greatest degree of severity of restriction in ROM (shoulder abduction and external rotation) was observed in the first year post-surgery, consistent with other longitudinal studies of AM (e.g., [64]). For shoulder abduction, the degree of restriction seen 2 years post-surgery was also significantly greater than that observed 5 years later.…”

Navigation surgery for intraoperative sentinel lymph node detection using Indocyanine green (ICG) fluorescence real-time imaging in breast cancer

“…For patients with early-stage breast cancer who have clinically negative axillary lymph nodes, SLNB is a method for staging the axilla that is associated with less morbidity than axillary lymph node dissection (ALND) [4][5][6][7][8][9][10]. Currently, SLNB for breast cancer is usually performed using a radiocolloid method and/or a blue dye method [11].…”