title: Comparison of lymphedema in patients with axillary lymph node dissections to those with sentinel lymph node biopsy followed by immediate and delayed ALND.
abstract: OBJECTIVE
  The purpose of the study was to show that delayed axillary lymph node dissection (ALND) has higher rates of lymphedema compared with immediate ALND, using data from NSABP-B32 at Beaumont Hospital.
  
  
  METHODS
  NSABP B-32 at Beaumont had 207 patients with follow-up data on 199 patients, randomizing clinically negative axilla to sentinel lymph node biopsy (SLNB)+ALND (GrA N=98), and SLNB+cytology±ALND (GrB N=101). All patients had preoperative volumetric arm measurements and only node negatives had routine postoperative measurements assessing lymphedema for 36 months. We contacted node-positive patients for postoperative measurements for this study. Twenty-four and 15 cytology-positive patients had SLNB+ALND in GrA and GrB, respectively (SubGrA1 N=24; SubGrB1 N=15). Fourteen hematoxylin and eosin-positive patients had delayed ALND (SubGrB2a N=14).
  
  
  RESULTS
  Lymphedema rate for node-positive SLNB+ALND was 10.3% [SubGrA1 (3/24)+SubGrB1 (1/15)=4/39] and node-negative SLNB+ALND was 6.8% (SubGrA2=5/74). Lymphedema was 14.3% for delayed ALND in SubGrB2a (2 of 14) and 0% for 72 SLNBs in SubGrB2b. Our study comparing immediate and delayed ALND lymphedema was not statistically significant (10.3% vs. 14.3%, P=0.65). Comparing node-negative ALND (SubGrA2= 5/74=6.8%) to node-positive ALND (A1+B1+B2a=6/53=11.3%) was not statistically significant (P=0.52). Comparing lymphedema for node-negative ALND (SubGrA2) to SLNB (SubGrB2b) only approached significance (6.8% vs. 0%, P=0.058).
  
  
  CONCLUSIONS
  The rate of lymphedema was higher in delayed ALND but not statistically significant. Comparison, however, is difficult, given the limited sample size. We urge the other centers of NSABP-B32 to validate this, by contacting the node-positive patients for measurements. The lymphedema rate for SLNB alone was 0% and approached statistical significance when compared with node-negative ALND.
authors.affiliation: Department of Surgery, William Beaumont Hospital, Royal Oak, MI, USA.
authors.forename: Nafisa Kayam
authors.initials: NK
authors.lastname: Kuwajerwala
authors.forename: Claire
authors.initials: C
authors.lastname: Feczko
authors.forename: Nayana
authors.initials: N
authors.lastname: Dekhne
authors.forename: Jane
authors.initials: J
authors.lastname: Pettinga
authors.forename: Victoria C
authors.initials: VC
authors.lastname: Lucia
authors.forename: Justin
authors.initials: J
authors.lastname: Riutta
authors.forename: Frank
authors.initials: F
authors.lastname: Vicini
mesh_terms: D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008197:Lymph Node Excision / Q000009:adverse effects* / Q000379:methods*; D008209:Lymphedema / Q000453:epidemiology* / Q000209:etiology; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects*; D013997:Time Factors