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Morbidity of Sentinel Node Biopsy: Relationship Between Number of Excised Lymph Nodes and Patient Perceptions of Lymphedema

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

Abstract

Background

Sentinel lymph node biopsy (SLNB) is associated with reduced morbidity, although lymphedema remains a significant complication. Previously, we found no association between number of excised lymph nodes (LNs) and measured lymphedema in SLNB patients. In this analysis, we examined the relationship between number of LNs excised during SLNB and patient-perceived lymphedema.

Methods

A total of 600 women who underwent SLNB for breast cancer were prospectively studied. Measured lymphedema was evaluated by circumferential bilateral upper-extremity measurements taken preoperatively and 3–8 years postoperatively. Patient-perceived lymphedema was evaluated by interview at follow-up. The relationship between lymphedema, total LNs excised, and clinicopathologic variables was assessed with Fisher’s exact test, Wilcoxon rank-sum test, kappa statistic, and McNemar’s test.

Results

At a median of 5 years, 18 (3%) patients reported perceived lymphedema. More LNs were excised in patients with perceived lymphedema compared with those without (median, 5.5 vs. 3; p = 0.01). Only 6 of 18 women with perceived lymphedema had objectively measured lymphedema (kappa = 0.22). Patients with numbness more likely reported perceived lymphedema (p = 0.03) and had more LNs excised (p = 0.02). Women with surgery on the nondominant axilla were less likely to perceive arm swelling, regardless of the presence of measured lymphedema.

Conclusions

After SLNB alone, patient-perceived lymphedema is uncommon, but its prevalence increases with more LNs excised. There is poor agreement between patient perceptions and objective measures. Our data suggest that factors other than limb enlargement, such as sensory nerve injury resulting from retrieval of more LNs and laterality of surgery, may play a significant role in patient perception of lymphedema after SLNB.

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Disclosures

The authors report no commercial interest and no sources of financial or material support.

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Authors and Affiliations

  1. Breast Service, Department of Surgery, Evelyn H. Lauder Breast Center, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Jessica I. Goldberg BA, Monica Morrow MD & Kimberly J. Van Zee MS, MD

  2. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Elyn R. Riedel MA

  3. Weill Medical College, Cornell University, New York, NY, USA

    Monica Morrow MD & Kimberly J. Van Zee MS, MD

Authors
  1. Jessica I. Goldberg BA
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  2. Elyn R. Riedel MA
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  3. Monica Morrow MD
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  4. Kimberly J. Van Zee MS, MD
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Correspondence to Kimberly J. Van Zee MS, MD.

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Goldberg, J.I., Riedel, E.R., Morrow, M. et al. Morbidity of Sentinel Node Biopsy: Relationship Between Number of Excised Lymph Nodes and Patient Perceptions of Lymphedema. Ann Surg Oncol 18, 2866–2872 (2011). https://doi.org/10.1245/s10434-011-1688-1

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  • DOI: https://doi.org/10.1245/s10434-011-1688-1

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