Morbidity after sentinel lymph node biopsy in primary breast cancer: results from a randomized controlled trial.
OBJECTIVE
Axillary lymph node dissection (ALND) as part of surgical treatment for patients with breast cancer is associated with significant morbidity. Sentinel lymph node biopsy (SLNB) is a newly developed method of staging the axilla and has the potential to avoid an ALND in lymph node-negative patients, thereby minimizing morbidity. The aim of this study was to investigate physical and psychological morbidity after SLNB in the treatment of early breast cancer in a randomized controlled trial.


METHODS
Between November 1999 and February 2003, 298 patients with early breast cancer (tumors 3 cm or less on ultrasound examination) who were clinically node negative were randomly allocated to undergo ALND (control group) or SLNB followed by ALND if subsequently found to be lymph node positive (study group). A detailed assessment of physical and psychological morbidity was performed during a 1-year period postoperatively.


RESULTS
A significant reduction in postoperative arm swelling, rate of seroma formation, numbness, loss of sensitivity to light touch and pinprick was observed in the study group. Although shoulder mobility was less impaired on average in the study group, this was significant only for abduction at 1 month and flexion at 3 months. Scores reflecting quality of life and psychological morbidity were significantly better in the study group in the immediate postoperative period, with fewer long-term differences.


CONCLUSIONS
SLNB in patients undergoing surgery for breast cancer results in a significant reduction in physical and psychological morbidity.
Purushotham
Anand David
AD
Cambridge Breast Unit Box 97, Addenbrooke's Hospital, Cambridge University Hospitals, NHS Foundation Trust, Hills Rd, Cambridge CB2 2QQ, United Kingdom. amy.byrtus@addenbrookes.nhs.uk
Upponi
Sara
S
Klevesath
Manfred Borislav
MB
Bobrow
Lynda
L
Millar
Keith
K
Myles
Jonathan Peter
JP
Duffy
Stephen William
SW
D001007:Anxiety / Q000453:epidemiology; D001943:Breast Neoplasms / Q000473:pathology / Q000523:psychology / Q000601:surgery*; D003863:Depression / Q000453:epidemiology; D005260:Female; D006801:Humans; D006987:Hypesthesia / Q000453:epidemiology; D008197:Lymph Node Excision / Q000009:adverse effects; D008207:Lymphatic Metastasis; D008209:Lymphedema / Q000453:epidemiology; D008875:Middle Aged; D011788:Quality of Life; D016059:Range of Motion, Articular; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects*; D049291:Seroma / Q000453:epidemiology