Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 12/2010

01-12-2010 | Breast Oncology

Morbidity of Sentinel Node Biopsy in Breast Cancer: The Relationship Between the Number of Excised Lymph Nodes and Lymphedema

Authors: Jessica I. Goldberg, BA, Lisa I. Wiechmann, MD, Elyn R. Riedel, MA, Monica Morrow, MD, Kimberly J. Van Zee, MS, MD

Published in: Annals of Surgical Oncology | Issue 12/2010

Login to get access

Abstract

Background

Despite the reduced morbidity associated with sentinel lymph node biopsy (SLNB), lymphedema remains a clinically relevant complication. We hypothesized that a higher number of lymph nodes (LNs) removed during SLNB is associated with a higher risk of lymphedema.

Methods

Six hundred patients with clinically node-negative breast cancer who underwent SLNB were prospectively studied. Circumferential bilateral upper extremity measurements were performed preoperatively and at 3–8 years after surgery. Association of lymphedema with total number of LNs excised and other clinicopathologic variables was analyzed by the Spearman rank correlation coefficient, Fisher’s exact test, Wilcoxon rank sum test, and logistic regression.

Results

At a median follow-up of 5 years, 5% of patients had developed lymphedema. Factors associated with lymphedema included weight and body mass index. There was no association between the number of LNs removed and the change in upper extremity measurements or in the incidence of lymphedema. Among patients with lymphedema (n = 31) compared to those without, the mean (3.9 vs. 4.2), median (4 vs. 3), and range (1–9 vs. 1–17) of number of LNs removed were similar (P = 0.93). Among the 33 women with ≥10 LNs removed, none developed lymphedema.

Conclusions

In this population of 600 women who underwent SLNB, there is no correlation between number of LNs removed and change in upper extremity circumference or incidence of lymphedema. These data suggest that other factors, such as the global disruption of the lymphatic channels during axillary lymph node dissection, play a larger role in development of lymphedema than does the number of LNs removed.
Literature
1.
Temple LK, Baron R, Cody HS III, et al. Sensory morbidity after sentinel lymph node biopsy and axillary dissection: a prospective study of 233 women. Ann Surg Oncol. 2002;9:654–62.CrossRefPubMed
2.
Baron RH, Fey JV, Borgen PI, et al. Eighteen sensations after breast cancer surgery: a 5-year comparison of sentinel lymph node biopsy and axillary lymph node dissection. Ann Surg Oncol. 2007;14:1653–61.CrossRefPubMed
3.
McLaughlin SA, Wright MJ, Morris KT, et al. Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: objective measurements. J Clin Oncol. 2008;26:5213–9.CrossRefPubMed
4.
McLaughlin SA, Wright MJ, Morris KT, et al. Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: patient perceptions and precautionary behaviors. J Clin Oncol. 2008;26:5220–6.CrossRefPubMed
5.
Sener SF, Winchester DJ, Martz CH, et al. Lymphedema after sentinel lymphadenectomy for breast carcinoma. Cancer. 2001;92:748–52.CrossRefPubMed
6.
Haid A, Koberle-Wuhrer R, Knauer M, et al. Morbidity of breast cancer patients following complete axillary dissection or sentinel node biopsy only: a comparative evaluation. Breast Cancer Res Treat. 2002;73:31–6.CrossRefPubMed
7.
Golshan M, Martin WJ, Dowlatshahi K. Sentinel lymph node biopsy lowers the rate of lymphedema when compared with standard axillary lymph node dissection. Am Surg. 2003;69:209–211.PubMed
8.
Ronka R, von Smitten K, Tasmuth T, Leidenius M. One-year morbidity after sentinel node biopsy and breast surgery. Breast. 2005;14:28–36.CrossRefPubMed
9.
Mansel RE, Fallowfield L, Kissin M, et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial. J Natl Cancer Inst. 2006;98:599–609.CrossRefPubMed
10.
Langer I, Guller U, Berclaz G, et al. Morbidity of sentinel lymph node biopsy (SLN) alone versus SLN and completion axillary lymph node dissection after breast cancer surgery: a prospective Swiss multicenter study on 659 patients. Ann Surg. 2007;245:452–61.CrossRefPubMed
11.
Schrenk P, Rieger R, Shamiyeh A, Wayand W. Morbidity following sentinel lymph node biopsy versus axillary lymph node dissection for patients with breast carcinoma. Cancer. 2000;88:608–14.CrossRefPubMed
12.
Wilke LG, McCall LM, Posther KE, et al. Surgical complications associated with sentinel lymph node biopsy: results from a prospective international cooperative group trial. Ann Surg Oncol. 2006;13:491–500.CrossRefPubMed
13.
Lucci A, McCall LM, Beitsch PD, et al. Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the American College of Surgeons Oncology Group Trial Z0011. J Clin Oncol. 2007;25:3657–63.CrossRefPubMed
14.
Meeske KA, Sullivan-Halley J, Smith AW, et al. Risk factors for arm lymphedema following breast cancer diagnosis in black women and white women. Breast Cancer Res Treat. 2009;113:383–91.CrossRefPubMed
15.
Herd-Smith A, Russo A, Muraca MG, Del Turco MR, Cardona G. Prognostic factors for lymphedema after primary treatment of breast carcinoma. Cancer. 2001;92:1783–7.CrossRefPubMed
16.
Paskett ED, Naughton MJ, McCoy TP, Case LD, Abbott JM. The epidemiology of arm and hand swelling in premenopausal breast cancer survivors. Cancer Epidemiol Biomarkers Prev. 2007;16:775–82.CrossRefPubMed
17.
Chagpar AB, Carlson DJ, Laidley AL, et al. Factors influencing the number of sentinel lymph nodes identified in patients with breast cancer. Am J Surg. 2007;194:860–4.CrossRefPubMed
18.
Cody HS 3rd, Borgen PI. State-of-the-art approaches to sentinel node biopsy for breast cancer: study design, patient selection, technique, and quality control at Memorial Sloan-Kettering Cancer Center. Surg Oncol. 1999;8:85–91.CrossRefPubMed
19.
Veronesi U, Paganelli G, Viale G, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med. 2003;349:546–53.CrossRefPubMed
20.
Kwan W, Jackson J, Weir LM, et al. Chronic arm morbidity after curative breast cancer treatment: prevalence and impact on quality of life. J Clin Oncol. 2002;20:4242–8.CrossRefPubMed
21.
Petrek JA, Senie RT, Peters M, Rosen PP. Lymphedema in a cohort of breast carcinoma survivors 20 years after diagnosis. Cancer. 2001;92:1368–77.CrossRefPubMed
22.
Beaulac SM, McNair LA, Scott TE, LaMorte WW, Kavanah MT. Lymphedema and quality of life in survivors of early-stage breast cancer. Arch Surg. 2002;137:1253–7.CrossRefPubMed
23.
Roses DF, Brooks AD, Harris MN, Shapiro RL, Mitnick J. Complications of level I and II axillary dissection in the treatment of carcinoma of the breast. Ann Surg. 1999;230:194–201.CrossRefPubMed
24.
Goffman TE, Laronga C, Wilson L, Elkins D. Lymphedema of the arm and breast in irradiated breast cancer patients: risks in an era of dramatically changing axillary surgery. Breast J. 2004;10:405–11.CrossRefPubMed
25.
Hinrichs CS, Watroba NL, Rezaishiraz H, et al. Lymphedema secondary to postmastectomy radiation: incidence and risk factors. Ann Surg Oncol. 2004;11:573–80.CrossRefPubMed
26.
Kuehn T, Klauss W, Darsow M, et al. Long-term morbidity following axillary dissection in breast cancer patients—clinical assessment, significance for life quality and the impact of demographic, oncologic and therapeutic factors. Breast Cancer Res Treat. 2000;64:275–86.CrossRefPubMed
27.
McCredie MR, Dite GS, Porter L, et al. Prevalence of self-reported arm morbidity following treatment for breast cancer in the Australian Breast Cancer Family Study. Breast. 2001;10:515–22.CrossRefPubMed
28.
Clark B, Sitzia J, Harlow W. Incidence and risk of arm oedema following treatment for breast cancer: a three-year follow-up study. Q J Med. 2005;98:343–8.
29.
Soran A, D’Angelo G, Begovic M, et al. Breast cancer-related lymphedema—what are the significant predictors and how they affect the severity of lymphedema? Breast J. 2006;12:536–43.CrossRefPubMed
30.
Helyer LK, Varnic M, Le LW, Leong W, McCready D. Obesity is a risk factor for developing postoperative lymphedema in breast cancer patients. Breast J. 2010;16:48–54.CrossRefPubMed
31.
Yen TW, Fan X, Sparapani R, et al. A contemporary, population-based study of lymphedema risk factors in older women with breast cancer. Ann Surg Oncol. 2009;16:979–88.CrossRefPubMed
32.
Lynch MA, Jackson J, Kim JA, Leeming RA. Optimal number of radioactive sentinel lymph nodes to remove for accurate axillary staging of breast cancer. Surgery. 2008;144:525–31.CrossRefPubMed
33.
Povoski SP, Young DC, Walker MJ, et al. Re-emphasizing the concept of adequacy of intraoperative assessment of the axillary sentinel lymph nodes for identifying nodal positivity during breast cancer surgery. World J Surg Oncol. 2007;5:18.CrossRefPubMed
34.
Zakaria S, Degnim AC, Kleer CG, et al. Sentinel lymph node biopsy for breast cancer: how many nodes are enough? J Surg Oncol. 2007;96:554–9.CrossRefPubMed
35.
Woznick A, Franco M, Bendick P, Benitez PR. Sentinel lymph node dissection for breast cancer: how many nodes are enough and which technique is optimal? Am J Surg. 2006;191:330–3.CrossRefPubMed
36.
McCarter MD, Yeung H, Fey J, Borgen PI, Cody HS 3rd. The breast cancer patient with multiple sentinel nodes: when to stop? J Am Coll Surg. 2001;192:692–7.CrossRefPubMed
37.
Chagpar AB, Scoggins CR, Martin RC 2nd, et al. Are 3 sentinel nodes sufficient? Arch Surg. 2007;142:456–9.CrossRefPubMed
38.
Low KS, Littlejohn DR. Optimal number of sentinel nodes after intradermal injection isotope and blue dye. ANZ J Surg. 2006;76:472–5.CrossRefPubMed
39.
Schrenk P, Rehberger W, Shamiyeh A, Wayand W. Sentinel node biopsy for breast cancer: does the number of sentinel nodes removed have an impact on the accuracy of finding a positive node? J Surg Oncol. 2002;80:130–6.CrossRefPubMed
40.
Morrow M, Evans J, Rosen PP, Kinne DW. Does clearing of axillary lymph nodes contribute to accurate staging of breast carcinoma? Cancer. 1984;53:1329–32.CrossRefPubMed
41.
Port ER, Patil S, Stempel M, Morrow M, Cody HS 3rd. Number of lymph nodes removed in sentinel lymph node-negative breast cancer patients is significantly related to patient age and tumor size: a new source of bias in morbidity assessment? Cancer. 2010;116:1987–91.CrossRefPubMed
42.
Goyal A, Newcombe RG, Chhabra A, Mansel RE. Factors affecting failed localisation and false-negative rates of sentinel node biopsy in breast cancer—results of the ALMANAC validation phase. Breast Cancer Res Treat. 2006;99:203–8.CrossRefPubMed
43.
Sclafani LM, Baron RH. Sentinel lymph node biopsy and axillary dissection: added morbidity of the arm, shoulder and chest wall after mastectomy and reconstruction. Cancer J. 2008;14:216–22.CrossRefPubMed
Metadata
Title
Morbidity of Sentinel Node Biopsy in Breast Cancer: The Relationship Between the Number of Excised Lymph Nodes and Lymphedema
Authors
Jessica I. Goldberg, BA
Lisa I. Wiechmann, MD
Elyn R. Riedel, MA
Monica Morrow, MD
Kimberly J. Van Zee, MS, MD
Publication date
01-12-2010
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 12/2010
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-010-1155-4

Other articles of this Issue 12/2010

Annals of Surgical Oncology 12/2010 Go to the issue

Gynecologic Oncology

Para-aortic Lymphadenectomy in the Management of Preoperative Grade 1 Endometrial Cancer Confined to the Uterine Corpus

Breast Oncology

Experience with Seed Localization for Nonpalpable Breast Lesions in a Public Health Care System

Translational Research and Biomarkers

Knockdown of Thrombomodulin Enhances HCC Cell Migration through Increase of ZEB1 and Decrease of E-cadherin Gene Expression

Gastrointestinal Oncology

The Fibroblast Growth Factor Receptor-4 Arg388 Allele is Associated with Gastric Cancer Progression

Thoracic Oncology

Influence of Neoadjuvant Chemoradiation on the Number and Size of Analyzed Lymph Nodes in Esophageal Cancer

Head and Neck Oncology

Recurrent Pleomorphic Adenoma: Results of Surgical Treatment