title: Incidence and time path of lymphedema in sentinel node negative breast cancer patients: a systematic review.
abstract: OBJECTIVE
  To systematically assess the incidence/prevalence and time path of lymphedema in patients with sentinel node-negative breast cancer.
  
  
  METHODS
  A systematic literature search up to November 2013 was performed using 4 different electronic databases: PubMed, Embase, Cochrane Clinical Trials, and Web of Science.
  
  
  METHODS
  Inclusion criteria were as follows: (1) research studies that included breast cancer patients who were surgically treated using the sentinel lymph node biopsy (SLNB) technique; (2) sentinel node-negative patients; (3) studies that investigated lymphedema as a primary or secondary outcome; (4) data extraction for the incidence or time path of lymphedema was possible; and (5) publication date starting from January 1, 2001. Exclusion criteria were as follows: (1) reviews or case studies; (2) patients who had an SLNB followed by an axillary lymph node dissection (ALND); (3) results of ALND patients and SLNB patients not described separately; and (4) studies not written in English.
  
  
  METHODS
  After scoring the methodological quality of the selected studies, the crude data concerning the incidence of lymphedema were extracted. Data concerning the time points and the incidence of lymphedema were also extracted.
  
  
  RESULTS
  Twenty-eight articles were included, representing 9588 SLNB-negative patients. The overall incidence of lymphedema in patients with sentinel node-negative breast cancer ranged from 0% to 63.4%. The studies that have assessed lymphedema at predefined time points, instead of a mean follow-up time, demonstrated an incidence range at ≤3, 6, 12, 18, or >18 months postsurgery of 3.2% to 5%, 2% to 10%, 3% to 63.4%, 6.6% to 7%, and 6.9% to 8.2%, respectively.
  
  
  CONCLUSIONS
  In SLNB patients, lymphedema is still a problem, mostly occurring 6 to 12 months after surgery. Because of different assessments and criteria, there is a wide range in incidence. Clear definitions of lymphedema are absolutely necessary to tailor therapy.
authors: Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium. Electronic address: nick.gebruers@uantwerpen.be.
authors: Nick
authors: N
authors: Gebruers
authors: Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
authors: Hanne
authors: H
authors: Verbelen
authors: Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
authors: Tessa
authors: T
authors: De Vrieze
authors: Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
authors: Dorith
authors: D
authors: Coeck
authors: Multidisciplinary Breast Clinic, Antwerp University Hospital, Edegem, Belgium; Department of Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
authors: Wiebren
authors: W
authors: Tjalma
mesh_terms: D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008209:Lymphedema / Q000209:etiology*; D015995:Prevalence; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects*; D013997:Time Factors
keywords: Breast neoplasms; Lymphedema; Rehabilitation; Review; Sentinel lymph node biopsy