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

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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.

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References

  1. Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P (2007) Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol 18:581–592

    Article  CAS  PubMed  Google Scholar 

  2. Kootstra JJ, Hoekstra-Weebers JEHM, Rietman JS, de Vries J, Baas PC, Geertzen JHB et al (2010) A longitudinal comparison of arm morbidity in stage I-II breast cancer patients treated with sentinel lymph node biopsy, sentinel lymph node biopsy followed by completion lymph node dissection, or axillary lymph node dissection. Ann Surg Oncol 17:2384–2394

    Article  PubMed Central  PubMed  Google Scholar 

  3. Brar P, Jain S, Singh I (2011) Complications of axillary lymph node dissection in treatment of early breast cancer: a comparison of MRM and BCS. Indian J Surg Oncol 2:126–132

    Article  PubMed Central  PubMed  Google Scholar 

  4. Liu C, Guo Y, Shi J, Sheng Y (2009) Late morbidity associated with a tumour-negative sentinel lymph node biopsy in primary breast cancer patients: a systematic review. Eur J Cancer 45:1560–1568

    Article  PubMed  Google Scholar 

  5. Bergmann A, Mendes VV, de Almeida Dias R, do Amaral Silva EB, da Costa Leite Ferreira MG, Fabro EAN (2012) Incidence and risk factors for axillary web syndrome after breast cancer surgery. Breast Cancer Res Treat 131:987–992

    Article  PubMed  Google Scholar 

  6. Aerts PDM, De Vries J, Van der Steeg FW, Roukema JA (2011) The relationship between morbidity after axillary surgery and long-term quality of life in breast cancer patients: the role of anxiety. Eur J Surg Oncol 37:344–349

    Article  CAS  PubMed  Google Scholar 

  7. Ashikaga T, Krag DN, Land SR, Julian TB, Anderson SJ, Brown AM et al (2010) Morbidity results from the NSABP B-32 trial comparing sentinel lymph node dissection versus axillary dissection. J Surg Oncol 102:111–118

    Article  PubMed Central  PubMed  Google Scholar 

  8. Belmonte R, Garin O, Segura M, Pont A, Escalada F, Ferrer M (2012) Quality-of-life impact of sentinel lymph node biopsy versus axillary lymph node dissection in breast cancer patients. Value Health 15:907–915

    Article  PubMed  Google Scholar 

  9. Rietman JS, Dijkstra PU, Geertzen JHB, Baas P, de Vries J, Dolsma WV et al (2004) Treatment-related upper limb morbidity 1 year after sentinel lymph node biopsy or axillary lymph node dissection for stage I or II breast cancer. Ann Surg Oncol 11:1018–1024

    Article  CAS  PubMed  Google Scholar 

  10. Rietman JS, Geertzen JHB, Hoekstra HJ, Baas P, Dolsma WV, de Vries J et al (2006) Long term treatment related upper limb morbidity and quality of life after sentinel lymph node biopsy for stage I or II breast cancer. Eur J Surg Oncol 32:148–152

    Article  CAS  PubMed  Google Scholar 

  11. Rietman JS, Dijkstra PU, Geertzen JHB, Baas P, De Vries J, Dolsma W et al (2003) Short-term morbidity of the upper limb after sentinel lymph node biopsy or axillary lymph node dissection for stage I or II breast carcinoma. Cancer 98:690–696

    Article  PubMed  Google Scholar 

  12. Land SR, Kopec JA, Julian TB, Brown AM, Anderson SJ, Krag DN et al (2010) Patient-reported outcomes in sentinel node-negative adjuvant breast cancer patients receiving sentinel-node biopsy or axillary dissection: National Surgical Adjuvant Breast and Bowel Project phase III protocol B-32. J Clin Oncol 28:3929–3936

    Article  PubMed  Google Scholar 

  13. Favarao KU, Mantse JC, Barros AC (2010) Shoulder mobility after axillary sentinel lymph node biopsy for early infiltrating breast cancer treatment. Eur J Gynaecol Oncol 31:23–26

    CAS  PubMed  Google Scholar 

  14. Crane-Okada R, Wascher RA, Elashoff D, Giuliano AE (2008) Long-term morbidity of sentinel node biopsy versus complete axillary dissection for unilateral breast cancer. Ann Surg Oncol 15:1996–2005

    Article  PubMed  Google Scholar 

  15. Langer I, Guller U, Berclaz G, Koechli OR, Schaer G, Fehr MK et al (2007) 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 245:452–461

    Article  PubMed  Google Scholar 

  16. Husen M, Paaschburg B, Flyger HL (2006) Two-step axillary operation increases risk of arm morbidity in breast cancer patients. Breast 15:620–628

    Article  CAS  PubMed  Google Scholar 

  17. Schulze T, Mucke J, Markwardt J, Schlag PM, Bembenek A (2006) Long-term morbidity of patients with early breast cancer after sentinel lymph node biopsy compared to axillary lymph node dissection. J Surg Oncol 29:109–119

    Article  Google Scholar 

  18. Kootstra JJ, Dijkstra PU, Rietman H, de Vries J, Baas P, Geertzen JHB et al (2013) A longitudinal study of shoulder and arm morbidity in breast cancer survivors 7 years after sentinel lymph node biopsy or axillary lymph node dissection. Breast Cancer Res Treat 139:125–134

    Article  PubMed  Google Scholar 

  19. Barranger E, Dubernard G, Fleurence J, Antoine M, Darai E (2005) Uzan: subjective morbidity and quality of life after sentinel node biopsy and axillary lymph node dissection for breast cancer. J Surg Oncol 92:17–22

    Article  PubMed  Google Scholar 

  20. Fleissig A, Fallowfield LJ, Langridge CI, Johnson L, Newcombe RG, Dixon JM et al (2006) 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 95:279–293

    Article  PubMed  Google Scholar 

  21. Rönkä R, von Smitten K, Tasmuth T, Leidenius M (2005) One-year morbidity after sentinel node biopsy and breast surgery. Breast 14:28–36

    Article  PubMed  Google Scholar 

  22. Langer S, Guenther JM, Haigh PI, Difronzo LA (2004) Lymphatic mapping improves staging and reduces morbidity in women undergoing total mastectomy for breast carcinoma. Am Surg 70:881–885

    PubMed  Google Scholar 

  23. Arnaud S, Houvenaeghel G, Moutardier V, Butarelli M, Martino M, Tallet A et al (2004) Patients’ and surgeons’ perspectives on axillary surgery for breast cancer. Eur J Surg Oncol 30:735–743

    Article  CAS  PubMed  Google Scholar 

  24. Peintinger F, Reitsamer R, Stranzl H, Ralph G (2003) Comparison of quality of life and arm complaints after axillary lymph node dissection vs sentinel lymph node biopsy in breast cancer patients. Br J Cancer 89:648–652

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Leidenius M, Leppänen E, Krogerus L, von Smitten K (2003) Motion restriction and axillary web syndrome after sentinel node biopsy and axillary clearance in breast cancer. Am J Surg 185:127–130

    Article  PubMed  Google Scholar 

  26. Haid A, Köberle-Wührer R, Knauer M, Burtscher J, Fritzsche H, Peschina W et al (2002) Morbidity of breast cancer patients following complete axillary dissection or sentinel node biopsy only: a comparative evaluation. Breast Cancer Res Treat 73:31–36

    Article  PubMed  Google Scholar 

  27. Haid A, Kuehn T, Konstantiniuk P, Köberle-Wührer R, Knauer M, Kreienberg R et al (2002) Shoulder–arm morbidity following axillary dissection and sentinel node only biopsy for breast cancer. Eur J Surg Oncol 28:705–710

    Article  CAS  PubMed  Google Scholar 

  28. Burak WE, Hollenbeck ST, Zervos EE, Hock KL, Kemp LC, Young DC (2002) Sentinel lymph node biopsy results in less postoperative morbidity compared with axillary lymph node dissection for breast cancer. Am J Surg 183:23–27

    Article  PubMed  Google Scholar 

  29. Purushotham AD, Upponi S, Klevesath MB, Bobrow L, Millar K, Myles JP et al (2005) Morbidity after sentinel lymph node biopsy in primary breast cancer: results from a randomized controlled trial. J Clin Oncol 23:4312–4321

    Article  PubMed  Google Scholar 

  30. Helms G, Kühn T, Moser L, Remmel E, Kreienberg R (2009) Shoulder-arm morbidity in patients with sentinel node biopsy and complete axillary dissection–data from a prospective randomised trial. Eur J Surg Oncol 35:696–701

    Article  CAS  PubMed  Google Scholar 

  31. Mansel RE, Fallowfield L, Kissin M, Goyal A, Newcombe RG, Dixon JM et al (2006) Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial. J Natl Cancer Inst 98:599–609

    Article  PubMed  Google Scholar 

  32. Swenson KK (2002) Comparison of side effects between sentinel lymph node and axillary lymph node dissection for breast cancer. Ann Surg Oncol 9:745–753

    Article  PubMed  Google Scholar 

  33. Wernicke AG, Shamis M, Sidhu KK, Turner BC, Goltser Y, Khan I et al (2013) Complication rates in patients with negative axillary nodes 10 years after local breast radiotherapy after either sentinel lymph node dissection or axillary clearance. Am J Clin Oncol 36:12–19

    Article  PubMed  Google Scholar 

  34. Srivastava V, Basu S, Shukla VK (2012) Seroma formation after breast cancer surgery: what we have learned in the last two decades. J Breast Cancer 15:373–380

    Article  PubMed Central  PubMed  Google Scholar 

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium

    Hanne Verbelen, Nick Gebruers, Fau-Mei Eeckhout & Kim Verlinden

  2. Breast Clinic, University Hospital of Antwerp (UZA), Wilrijkstraat 10, 2650, Edegem, Belgium

    Wiebren Tjalma

  3. Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium

    Wiebren Tjalma

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  1. Hanne Verbelen
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  2. Nick Gebruers
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  3. Fau-Mei Eeckhout
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Correspondence to Nick Gebruers.

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Verbelen, H., Gebruers, N., Eeckhout, FM. et al. Shoulder and arm morbidity in sentinel node-negative breast cancer patients: a systematic review. Breast Cancer Res Treat 144, 21–31 (2014). https://doi.org/10.1007/s10549-014-2846-5

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  • DOI: https://doi.org/10.1007/s10549-014-2846-5

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