Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: objective measurements.
OBJECTIVE
Sentinel lymph node biopsy was adopted for the staging of the axilla with the assumption that it would reduce the risk of lymphedema in women with breast cancer. The aim of this study was to determine the long-term prevalence of lymphedema after SLN biopsy (SLNB) alone and after SLNB followed by axillary lymph node dissection (SLNB/ALND).


METHODS
At median follow-up of 5 years, lymphedema was assessed in 936 women with clinically node-negative breast cancer who underwent SLNB alone or SLNB/ALND. Standardized ipsilateral and contralateral measurements at baseline and follow-up were used to determine change in ipsilateral upper extremity circumference and to control for baseline asymmetry and weight change. Associations between lymphedema and potential risk factors were examined.


RESULTS
Of the 936 women, 600 women (64%) underwent SLNB alone and 336 women (36%) underwent SLNB/ALND. Patients having SLNB alone were older than those having SLNB/ALND (56 v 52 years; P < .0001). Baseline body mass index (BMI) was similar in both groups. Arm circumference measurements documented lymphedema in 5% of SLNB alone patients, compared with 16% of SLNB/ALND patients (P < .0001). Risk factors associated with measured lymphedema were greater body weight (P < .0001), higher BMI (P < .0001), and infection (P < .0001) or injury (P = .02) in the ipsilateral arm since surgery.


CONCLUSIONS
When compared with SLNB/ALND, SLNB alone results in a significantly lower rate of lymphedema 5 years postoperatively. However, even after SLNB alone, there remains a clinically relevant risk of lymphedema. Higher body weight, infection, and injury are significant risk factors for developing lymphedema.
Breast Service, Department of Surgery, Behavioral Science Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Sarah A
SA
McLaughlin
Mary J
MJ
Wright
Katherine T
KT
Morris
Gladys L
GL
Giron
Michelle R
MR
Sampson
Julia P
JP
Brockway
Karen E
KE
Hurley
Elyn R
ER
Riedel
Kimberly J
KJ
Van Zee
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects*; D008209:Lymphedema / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D008875:Middle Aged; D009367:Neoplasm Staging; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors