title: Arm lymphoedema after axillary surgery in women with invasive breast cancer.
abstract: BACKGROUND
  The primary aim was to compare arm lymphoedema after sentinel lymph node biopsy (SLNB) alone versus axillary lymph node dissection (ALND) in women with node-negative and node-positive breast cancer. The secondary aim was to examine the potential association between self-reported and objectively measured arm lymphoedema.
  
  
  METHODS
  Women who had surgery during 1999-2004 for invasive breast cancer in four centres in Sweden were included. The study groups were defined by the axillary procedure performed and the presence of axillary metastases: SLNB alone, ALND without axillary metastases, and ALND with axillary metastases. Before surgery, and 1, 2 and 3 years after operation, arm volume was measured and a questionnaire regarding symptoms of arm lymphoedema was completed. A mixed model was used to determine the adjusted mean difference in arm volume between the study groups, and generalized estimating equations were employed to determine differences in self-reported arm lymphoedema.
  
  
  RESULTS
  One hundred and forty women had SLNB alone, 125 had node-negative ALND and 155 node-positive ALND. Women who underwent SLNB had no increase in postoperative arm volume over time, whereas both ALND groups showed a significant increase. The risk of self-reported arm lymphoedema 1, 2 and 3 years after surgery was significantly lower in the SLNB group compared with that in both ALND groups. Three years after surgery there was a significant association between increased arm volume and self-reported symptoms of arm lymphoedema.
  
  
  CONCLUSIONS
  SLNB is associated with a minimal risk of increased arm volume and few symptoms of arm lymphoedema, significantly less than after ALND, regardless of lymph node status.
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institute and Karolinska University Hospital, Stockholm.
authors.forename: H
authors.initials: H
authors.lastname: Sackey
authors.forename: A
authors.initials: A
authors.lastname: Magnuson
authors.forename: K
authors.initials: K
authors.lastname: Sandelin
authors.forename: G
authors.initials: G
authors.lastname: Liljegren
authors.forename: L
authors.initials: L
authors.lastname: Bergkvist
authors.forename: Z
authors.initials: Z
authors.lastname: Fülep
authors.forename: F
authors.initials: F
authors.lastname: Celebioglu
authors.forename: J
authors.initials: J
authors.lastname: Frisell
mesh_terms: D001132:Arm; D001365:Axilla / Q000601:surgery; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects*; D008209:Lymphedema / Q000209:etiology*; D008408:Mastectomy / Q000379:methods; D015412:Mastectomy, Segmental; D008875:Middle Aged; D011446:Prospective Studies; D057566:Self Report; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects