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

Objective:To assess the morbidity after sentinel lymph node (SLN) biopsy compared with SLN and completion level I and II axillary lymph node dissection (ALND) in a prospective multicenter study. Summary Background Data:ALND after breast cancer surgery is associated with considerable morbidity. We hypothesized: 1) that the morbidity in patients undergoing SLN biopsy only is significantly lower compared with those after SLN and completion ALND level I and II; and 2) that SLN biopsy can be performed with similar intermediate term morbidity in academic and nonacademic centers. Methods:Patients with early stage breast cancer (pT1 and pT2 ≤ 3 cm, cN0) were included between January 2000 and December 2003 in this prospective Swiss multicenter study. All patients underwent SLN biopsy. In all patients with SLN macrometastases and most patients with SLN micrometastases (43 of 68) or isolated tumor cells (11 of 19), a completion ALND was performed. Postoperative morbidity was assessed based on a standardized protocol. Results:SLN biopsy alone was performed in 449 patients, whereas 210 patients underwent SLN and completion ALND. The median follow-ups were 31.0 and 29.5 months for the SLN and SLN and completion ALND groups, respectively. Intermediate-term follow-up information was available from 635 of 659 patients (96.4%) of enrolled patients. The following results were found in the SLN versus SLN and completion ALND group: presence of lymphedema (3.5% vs. 19.1%, P < 0.0001), impaired shoulder range of motion (3.5% vs. 11.3%, P < 0.0001), shoulder/arm pain (8.1% vs. 21.1%, P < 0.0001), and numbness (10.9% vs. 37.7%, P < 0.0001). No significant differences regarding postoperative morbidity after SLN biopsy were noticed between academic and nonacademic hospitals (P = 0.921). Conclusions:The morbidity after SLN biopsy alone is not negligible but significantly lower compared with level I and II ALND. SLN biopsy can be performed with similar short- and intermediate-term morbidity in academic and nonacademic centers.

[1]  U. Chetty,et al.  Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial. , 2006, Journal of the National Cancer Institute.

[2]  Sheryl G. A. Gabram,et al.  Surgical Complications Associated With Sentinel Lymph Node Biopsy: Results From a Prospective International Cooperative Group Trial , 2006, Annals of Surgical Oncology.

[3]  E. Darai,et al.  Subjective morbidity and quality of life after sentinel node biopsy and axillary lymph node dissection for breast cancer , 2005, Journal of surgical oncology.

[4]  M. Leivonen,et al.  The consequences of long‐time arm morbidity in node‐negative breast cancer patients with sentinel node biopsy or axillary clearance , 2005, Journal of surgical oncology.

[5]  A. Giuliano,et al.  Sentinel Node Skills Verification and Surgeon Performance: Data From a Multicenter Clinical Trial for Early-Stage Breast Cancer , 2005, Annals of surgery.

[6]  S. Duffy,et al.  Morbidity after sentinel lymph node biopsy in primary breast cancer: results from a randomized controlled trial. , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[7]  H. Moch,et al.  Axillary Recurrence Rate in Breast Cancer Patients With Negative Sentinel Lymph Node (SLN) or SLN Micrometastases: Prospective Analysis of 150 Patients After SLN Biopsy , 2005, Annals of surgery.

[8]  P. Dijkstra,et al.  Treatment-Related Upper Limb Morbidity 1 Year after Sentinel Lymph Node Biopsy or Axillary Lymph Node Dissection for Stage I or II Breast Cancer , 2004, Annals of Surgical Oncology.

[9]  M. Kosir,et al.  Can a practicing surgeon detect early lymphedema reliably? , 2003, American journal of surgery.

[10]  R. Blamey,et al.  Incidence of clinically significant lymphoedema as a complication following surgery for primary operable breast cancer. , 2003, European journal of cancer.

[11]  F. Peintinger,et al.  Comparison of quality of life and arm complaints after axillary lymph node dissection vs sentinel lymph node biopsy in breast cancer patients , 2003, British Journal of Cancer.

[12]  Umberto Veronesi,et al.  A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. , 2003, The New England journal of medicine.

[13]  M. Schijven,et al.  Comparison of morbidity between axillary lymph node dissection and sentinel node biopsy. , 2003, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[14]  J. Donohue,et al.  Relapse and morbidity in patients undergoing sentinel lymph node biopsy alone or with axillary dissection for breast cancer. , 2003, Archives of surgery.

[15]  R. Kreienberg,et al.  Shoulder-arm morbidity following axillary dissection and sentinel node only biopsy for breast cancer. , 2002, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[16]  Mary J. Nissen,et al.  Comparison of side effects between sentinel lymph node and axillary lymph node dissection for breast cancer , 2002, Annals of Surgical Oncology.

[17]  A. Giuliano,et al.  The time has come to change the algorithm for the surgical management of early breast cancer. , 2002, Archives of surgery.

[18]  H. Thaler,et al.  Sensory morbidity after sentinel lymph node biopsy and axillary dissection: A prospective study of 233 women , 2002, Annals of Surgical Oncology.

[19]  L. Holmberg,et al.  Consequences of axillary recurrence after conservative breast surgery , 2002, The British journal of surgery.

[20]  R. Gelber,et al.  Meeting highlights: International Consensus Panel on the Treatment of Primary Breast Cancer. Seventh International Conference on Adjuvant Therapy of Primary Breast Cancer. , 2001, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[21]  K. Kahn,et al.  Arm edema in breast cancer patients. , 2001, Journal of the National Cancer Institute.

[22]  L. Tafra,et al.  Multicenter Trial of Sentinel Node Biopsy for Breast Cancer Using Both Technetium Sulfur Colloid and Isosulfan Blue Dye , 2001, Annals of surgery.

[23]  R. Kreienberg,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 , 2000, Breast Cancer Research and Treatment.

[24]  S. Singletary,et al.  Presentation, management and outcome of axillary recurrence from breast cancer. , 2000, American journal of surgery.

[25]  A E Giuliano,et al.  Prospective observational study of sentinel lymphadenectomy without further axillary dissection in patients with sentinel node-negative breast cancer. , 2000, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[26]  Andreas Shamiyeh,et al.  Morbidity following sentinel lymph node biopsy versus axillary lymph node dissection for patients with breast carcinoma , 2000, Cancer.

[27]  D. Roses,et al.  Complications of level I and II axillary dissection in the treatment of carcinoma of the breast. , 1999, Annals of surgery.

[28]  V. Velanovich,et al.  Quality of life of breast cancer patients with lymphedema. , 1999, American journal of surgery.

[29]  A E Giuliano,et al.  Sentinel lymphadenectomy in breast cancer. , 1997, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[30]  L. Holmberg,et al.  Arm morbidity after sector resection and axillary dissection with or without postoperative radiotherapy in breast cancer stage I. Results from a randomised trial. Uppsala-Orebro Breast Cancer Study Group. , 1997, European journal of cancer.

[31]  J R Casley-Smith,et al.  Measuring and representing peripheral oedema and its alterations. , 1994, Lymphology.

[32]  J. Brisson,et al.  Arm problems and psychological distress after surgery for breast cancer. , 1993, Canadian journal of surgery. Journal canadien de chirurgie.

[33]  K. Miller,et al.  Impact of axillary lymph node dissection on the therapy of breast cancer patients. , 1993, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[34]  G. Royle,et al.  Incidence of arm swelling following axillary clearance for breast cancer , 1992, The British journal of surgery.

[35]  J. Thomas,et al.  Radical axillary dissection in the staging and treatment of breast cancer. , 1992, Annals of the Royal College of Surgeons of England.

[36]  S. Borup Christensen,et al.  Sequelae of axillary dissection vs. axillary sampling with or without irradiation for breast cancer. A randomized trial. , 1989, Acta chirurgica Scandinavica.

[37]  A. Recht,et al.  Edema of the arm as a function of the extent of axillary surgery in patients with stage I-II carcinoma of the breast treated with primary radiotherapy. , 1986, International journal of radiation oncology, biology, physics.

[38]  P. Borgen,et al.  Eighteen sensations after breast cancer surgery: a two-year comparison of sentinel lymph node biopsy and axillary lymph node dissection. , 2004, Oncology nursing forum.

[39]  B. Kuru,et al.  Lymphedema after treatment of breast cancer. , 2004, American journal of surgery.

[40]  C. Ko,et al.  Beyond the Clinical Trials: How Often Is Sentinel Lymph Node Dissection Performed for Breast Cancer? , 2004, Annals of Surgical Oncology.

[41]  S. Hollenbeck,et al.  Sentinel lymph node biopsy results in less postoperative morbidity compared with axillary lymph node dissection for breast cancer. , 2002, American journal of surgery.

[42]  R. Love.  Meeting highlights: International Consensus Panel on the treatment of primary breast cancer. , 2002, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[43]  Robert A. Smith,et al.  Lymphedema: current issues in research and management. , 2000, CA: a cancer journal for clinicians.

[44]  M. Brennan,et al.  American Cancer Society Lymphedema Workshop. Workgroup III: Diagnosis and management of lymphedema. , 1998, Cancer.