title: Arm morbidity following sentinel lymph node biopsy or axillary lymph node dissection: a study from the Danish Breast Cancer Cooperative Group.
abstract: BACKGROUND
  Sentinel lymph node biopsy was implemented in the treatment of early breast cancer with the aim of reducing shoulder and arm morbidity. Relatively few prospective studies have been published where the morbidity was assessed by clinical examination. Very few studies have examined the impact on shoulder mobility of node positive patients having a secondary axillary dissection because of the findings of metastases postoperatively.
  
  
  OBJECTIVE
  We aimed to investigate the objective and subjective arm morbidity in node negative and node positive patients.
  
  
  METHODS
  In a prospective study, 395 patients with tumors less than 4 cm, were included. Patients were recruited from seven Danish breast cancer clinics. Both subjective and objective arm and shoulder morbidity were measured before, 6 and 18 months after the operation.
  
  
  RESULTS
  Comparing node negative patients having a sentinel lymph node biopsy with node negative patients having a lymph node dissection of levels I and II of the axilla, we found significant increase in arm volume among the patients who had an axillary dissection. Only minor, but significant, differences in shoulder mobility were observed comparing the two groups of node negative patients. Highly significant difference was found comparing sensibility. Comparing the morbidity in node positive patients who had a one-step axillary dissection with patients having a two-step procedure (sentinel lymph node biopsy followed by delayed axillary dissection) revealed no difference in objective or subjective arm morbidity.
  
  
  CONCLUSIONS
  Node negative patients operated with sentinel lymph node biopsy have less arm morbidity compared with node negative patients operated with axillary lymph node dissection. Node positive patients who had a secondary axillary lymph node dissection after sentinel lymph node biopsy had no difference in either objective or subjective morbidity compared with node positive patients having a one-step axillary dissection.
authors.affiliation: Department of Surgery, Aarhus University Hospital, JageHansensgade 2, 8000 Aarhus C, Denmark. husted@ki.au.dk
authors.forename: Anders
authors.initials: A
authors.lastname: Husted Madsen
authors.forename: Karen
authors.initials: K
authors.lastname: Haugaard
authors.forename: Jan
authors.initials: J
authors.lastname: Soerensen
authors.forename: Susanne
authors.initials: S
authors.lastname: Bokmand
authors.forename: Esbern
authors.initials: E
authors.lastname: Friis
authors.forename: Helle
authors.initials: H
authors.lastname: Holtveg
authors.forename: Jens
authors.initials: J
authors.lastname: Peter Garne
authors.forename: John
authors.initials: J
authors.lastname: Horby
authors.forename: Peer
authors.initials: P
authors.lastname: Christiansen
mesh_terms: D000328:Adult; D000368:Aged; D001132:Arm; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology*; D003718:Denmark; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000209:etiology*; D008197:Lymph Node Excision / Q000009:adverse effects*; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008209:Lymphedema / Q000209:etiology*; D008875:Middle Aged; D009017:Morbidity; D009367:Neoplasm Staging; D010525:Peripheral Nerves; D011446:Prospective Studies; D016059:Range of Motion, Articular; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects; D012785:Shoulder Joint; D020196:Trauma, Nervous System / Q000209:etiology*