Long-Term Morbidity of Sentinel Node Biopsy Versus Complete Axillary Dissection for Unilateral Breast Cancer
- 281 Downloads
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.
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).
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).
SLNB is associated with significantly less subjective and objective long-term morbidity than ALND.
Key WordsBreast cancer Sentinel node Symptoms Quality of life
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).
- 2.Ernst MF, Voogd AC, Balder W, et al. Early and late morbidity associated with axillary levels I–III dissection in breast cancer. J Surg Oncol 2002; 79:151–5Google Scholar
- 4.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; 20:4242–8Google Scholar
- 14.Fleissig A, Fallowfield LJ, Langridge CI, et al. Post-operative arm morbidity and quality of life. Results of the ALMANAC randomised trial comparing sentinel node biopsy with standard axillary treatment in the management of patients with early breast cancer. Breast Cancer Res Treat 2006; 95:279–93PubMedCrossRefGoogle Scholar
- 15.Gill PG, Gebski V, Wetzig N, et al. Sentinel node (SN) based management causes less arm swelling and better quality of life than routine axillary clearance (AC): 1 year outcomes of the SNAC trial. Breast Cancer Res Treat 2006; 100:S14Google Scholar