Lymphedema After SNB

Cancer 2001 Aug 15;92(4):748-52

Lymphedema after sentinel lymphadenectomy for breast carcinoma.

Sener SF, Winchester DJ, Martz CH, Feldman JL, Cavanaugh JA, Winchester DP, Weigel B, Bonnefoi K, Kirby K, Morehead C.

Department of Surgery, Evanston Northwestern Healthcare, 2650 Ridge, Burch 106, Evanston, IL 60201, USA.

BACKGROUND: Initial studies of sentinel lymphadenectomy for patients with breast carcinoma confirmed that the status of the sentinel lymph nodes was an accurate predictor of the presence of metastatic disease in the axillary lymph nodes.

Sentinel lymphadenectomy, as an axillary staging procedure, has risks of morbidity that have yet to be defined.

METHODS: Patients were enrolled in a two-phase protocol that included concurrent data collection of patient characteristics and treatment variables. During the first (validation) phase, 72 patients underwent sentinel lymph node excision followed by a level I-II axillary dissection. After the technique had been established, the second phase commenced, during which only patients with positive sentinel lymph nodes underwent an axillary dissection.

RESULTS: During the second phase, lymphedema was identified in 9 of 303 patients (3.0%) who underwent sentinel lymphadenectomy alone and in 20 of 117 patients (17.1%) who underwent sentinel lymphadenectomy combined with axillary dissection (P < 0.0001). Of 303 patients who underwent sentinel lymphadenectomy alone, 8 of 155 patients (5.1%) with tumors located in the upper outer quadrant and 1 of 148 patients (0.7%) with tumors in other locations developed lymphedema (P = 0.012).

CONCLUSIONS: The risk of developing lymphedema after undergoing sentinel lymphadenectomy was measurable but significantly lower than after undergoing axillary dissection.

Tumor location in the upper outer quadrant and postoperative trauma and/or infection were identifiable risk factors for lymphedema.

Copyright 2001 American Cancer Society.

Ann's NOTE: Jeannette Dixon of Falk Drugs (NYC), has been fitting people with sleeves and stockings for some years.

Recently she told me she is seeing cases of lymphedema in women who have had sentinel node biopsy performed. She suggests this is due to the extensive radiation they are recieving in the axilla.

Could radiologists not be aware of the much better results with SNB?

A recent study (see below)demonstrates that the current level of false negatives in sentinel nod biopsy ranges from 3-8%.

By contrast, axillary dissection false negative rate is 12-20%.

Nor are doctors seeing a large(r) number of local or other recurrences. This demonstrates that SNB is a reliable and safe method of dissection.

About False Negatives in SNB

Oncology Times, 7/02

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