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Long-Term Morbidity of Sentinel Node Biopsy Versus Complete Axillary Dissection for Unilateral Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Postoperative changes after axillary lymph node surgery may significantly alter breast cancer survivors’ (BCS) quality of life. Although sentinel lymph node biopsy (SLNB) has less immediate morbidity than axillary lymph node dissection (ALND), its long-term impact on shoulder abduction, arm swelling, and neurosensory changes has not been evaluated. The purpose of this study was to compare long-term morbidity after SLNB or ALND and breast-conservation surgery.

Methods

Female BCS who remained free of disease at least 3 years after ALND or SLNB for Stage I–III unilateral breast cancer completed a symptom questionnaire and a brief neurosensory physical examination of the upper arm and axilla (range of motion, arm circumference, and sensation to light touch with cotton and needle).

Results

The mean age of the 187 participating BCS was 62 years. At a mean follow-up of 6.6 years after ALND and 4.9 years after SLNB, most BCS had full abduction; only 10 cases (8 ALND, 2 SLNB) had a ≥2 cm proximal and/or distal circumference difference on the ipsilateral side compared with the contralateral side. ALND was associated with a significantly greater likelihood of subjective arm numbness (P < .001), chest or axillary numbness (P < .001), arm or hand swelling (P < .001), and objective neurosensory changes in the posterior axilla, medial and distal upper arm (P < .001). Operative procedure was the only significant predictor of neurosensory changes (P < .001).

Conclusion

SLNB is associated with significantly less subjective and objective long-term morbidity than ALND.

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Acknowledgments

From the Gonda (Goldschmied) Research Laboratories of the John Wayne Cancer Institute at Saint John’s Health Center. Supported by funding from the John Wayne Cancer Institute Auxiliary, the Ben B. and Joyce E. Eisenberg Foundation (Los Angeles, CA), the Fashion Footwear Association of New York Charitable Foundation (New York, NY), and the Associates for Breast and Prostate Cancer Studies (Santa Monica, CA).

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Authors and Affiliations

  1. Department of Surgical Oncology, John Wayne Cancer Institute at Saint John’s Health Center, Santa Monica, CA, USA

    Rebecca Crane-Okada PhD & Armando E. Giuliano MD

  2. City of Hope National Medical Center, 1500 E. Duarte Blvd., Duarte, CA, USA

    Rebecca Crane-Okada PhD

  3. Division of Surgical Oncology, Department of Surgery, Newark Beth Israel Medical Center, Newark, NJ, USA

    Robert A. Wascher MD

  4. Departments of Medicine and Biostatistics, University of California, Los Angeles, CA, USA

    David Elashoff PhD

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  1. Rebecca Crane-Okada PhD
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  2. Robert A. Wascher MD
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  3. David Elashoff PhD
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  4. Armando E. Giuliano MD
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Correspondence to Rebecca Crane-Okada PhD.

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Crane-Okada, R., Wascher, R.A., Elashoff, D. et al. Long-Term Morbidity of Sentinel Node Biopsy Versus Complete Axillary Dissection for Unilateral Breast Cancer. Ann Surg Oncol 15, 1996–2005 (2008). https://doi.org/10.1245/s10434-008-9909-y

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  • DOI: https://doi.org/10.1245/s10434-008-9909-y

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