This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Purushotham, A. D. Articles by Duffy, S. W. Search for Related Content PubMed PubMed Citation Articles by Purushotham, A. D. Articles by Duffy, S. W. Social Bookmarking                            What's this?

Morbidity After Sentinel Lymph Node Biopsy in Primary Breast Cancer: Results From a Randomized Controlled Trial

From the Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge University Hospitals, NHS Foundation Trust and University of Cambridge, Cambridge; Section of Psychological Medicine, University of Glasgow; Department of Epidemiology, Mathematics and Statistics, Cancer Research United Kingdom, London, United Kingdom, on behalf of the Cambridge/East Anglia Study Group

Address reprint requests to A.D. Purushotham, MD, Cambridge Breast Unit Box 97, Addenbrooke's Hospital, Cambridge University Hospitals, NHS Foundation Trust, Hills Rd, Cambridge CB2 2QQ, United Kingdom; e-mail: amy.byrtus{at}addenbrookes.nhs.uk

PURPOSE: Axillary lymph node dissection (ALND) as part of surgical treatment for patients with breast cancer is associated with significant morbidity. Sentinel lymph node biopsy (SLNB) is a newly developed method of staging the axilla and has the potential to avoid an ALND in lymph node–negative patients, thereby minimizing morbidity. The aim of this study was to investigate physical and psychological morbidity after SLNB in the treatment of early breast cancer in a randomized controlled trial.

PATIENTS AND METHODS: Between November 1999 and February 2003, 298 patients with early breast cancer (tumors 3 cm or less on ultrasound examination) who were clinically node negative were randomly allocated to undergo ALND (control group) or SLNB followed by ALND if subsequently found to be lymph node positive (study group). A detailed assessment of physical and psychological morbidity was performed during a 1-year period postoperatively.

RESULTS: A significant reduction in postoperative arm swelling, rate of seroma formation, numbness, loss of sensitivity to light touch and pinprick was observed in the study group. Although shoulder mobility was less impaired on average in the study group, this was significant only for abduction at 1 month and flexion at 3 months. Scores reflecting quality of life and psychological morbidity were significantly better in the study group in the immediate postoperative period, with fewer long-term differences.

CONCLUSION: SLNB in patients undergoing surgery for breast cancer results in a significant reduction in physical and psychological morbidity.

Supported by a grant from the Eastern Region Research and Development and the National Cancer Research Network.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				T. S. Dabakuyo, J. Fraisse, S. Causeret, S. Gouy, M.-M. Padeano, C. Loustalot, J. Cuisenier, J.-M. Sauzedde, M. Smail, J.-P. Combier, et al. A multicenter cohort study to compare quality of life in breast cancer patients according to sentinel lymph node biopsy or axillary lymph node dissection Ann. Onc., August 1, 2009; 20(8): 1352 - 1361. [Abstract] [Full Text] [PDF]

				K. Y. Bilimoria, D. J. Bentrem, N. M. Hansen, K. P. Bethke, A. W. Rademaker, C. Y. Ko, D. P. Winchester, and D. J. Winchester Comparison of Sentinel Lymph Node Biopsy Alone and Completion Axillary Lymph Node Dissection for Node-Positive Breast Cancer J. Clin. Oncol., June 20, 2009; 27(18): 2946 - 2953. [Abstract] [Full Text] [PDF]

				M. Gadd Sentinel lymph node biopsy for staging early breast cancer: minimizing the trade-off by maximizing the accuracy Ann. Onc., June 1, 2009; 20(6): 973 - 975. [Full Text] [PDF]

				S. A. McLaughlin, M. J. Wright, K. T. Morris, G. L. Giron, M. R. Sampson, J. P. Brockway, K. E. Hurley, E. R. Riedel, and K. J. Van Zee Prevalence of Lymphedema in Women With Breast Cancer 5 Years After Sentinel Lymph Node Biopsy or Axillary Dissection: Objective Measurements J. Clin. Oncol., November 10, 2008; 26(32): 5213 - 5219. [Abstract] [Full Text] [PDF]

				S. A. McLaughlin, M. J. Wright, K. T. Morris, M. R. Sampson, J. P. Brockway, K. E. Hurley, E. R. Riedel, and K. J. Van Zee Prevalence of Lymphedema in Women With Breast Cancer 5 Years After Sentinel Lymph Node Biopsy or Axillary Dissection: Patient Perceptions and Precautionary Behaviors J. Clin. Oncol., November 10, 2008; 26(32): 5220 - 5226. [Abstract] [Full Text] [PDF]

				L. K. Tan, D. Giri, A. J. Hummer, K. S. Panageas, E. Brogi, L. Norton, C. Hudis, P. I. Borgen, and H. S. Cody III Occult Axillary Node Metastases in Breast Cancer Are Prognostically Significant: Results in 368 Node-Negative Patients With 20-Year Follow-Up J. Clin. Oncol., April 10, 2008; 26(11): 1803 - 1809. [Abstract] [Full Text] [PDF]

				A. G.J. Van der Zee, M. H. Oonk, J. A. De Hullu, A. C. Ansink, I. Vergote, R. H. Verheijen, A. Maggioni, K. N. Gaarenstroom, P. J. Baldwin, E. B. Van Dorst, et al. Sentinel Node Dissection Is Safe in the Treatment of Early-Stage Vulvar Cancer J. Clin. Oncol., February 20, 2008; 26(6): 884 - 889. [Abstract] [Full Text] [PDF]

				S. K. Somasundaram, D. W. Chicken, and M. R. S. Keshtgar Detection of the sentinel lymph node in breast cancer Br. Med. Bull., January 3, 2008; (2008) ldm032v1. [Abstract] [Full Text] [PDF]

				A. Lucci, L. M. McCall, P. D. Beitsch, P. W. Whitworth, D. S. Reintgen, P. W. Blumencranz, A. M. Leitch, S. Saha, K. K. Hunt, and A. E. Giuliano Surgical Complications Associated With Sentinel Lymph Node Dissection (SLND) Plus Axillary Lymph Node Dissection Compared With SLND Alone in the American College of Surgeons Oncology Group Trial Z0011 J. Clin. Oncol., August 20, 2007; 25(24): 3657 - 3663. [Abstract] [Full Text] [PDF]

				A. Moseley, C. Carati, and N. Piller A systematic review of common conservative therapies for arm lymphoedema secondary to breast cancer treatment Ann. Onc., April 1, 2007; 18(4): 639 - 646. [Abstract] [Full Text] [PDF]

				S. L. Chen, D. M. Iddings, R. P. Scheri, and A. J. Bilchik Lymphatic Mapping and Sentinel Node Analysis: Current Concepts and Applications CA Cancer J Clin, September 1, 2006; 56(5): 292 - 309. [Abstract] [Full Text] [PDF]

				J. Pater and W. Parulekar Sentinel lymph node biopsy in early breast cancer: has its time come? J Natl Cancer Inst, May 3, 2006; 98(9): 568 - 569. [Full Text] [PDF]

				R. E. Mansel, L. Fallowfield, M. Kissin, A. Goyal, R. G. Newcombe, J. M. Dixon, C. Yiangou, K. Horgan, N. Bundred, I. Monypenny, et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial. J Natl Cancer Inst, May 3, 2006; 98(9): 599 - 609. [Abstract] [Full Text] [PDF]

				K. Kuroi, K. Shimozuma, T. Taguchi, H. Imai, H. Yamashiro, S. Ohsumi, and S. Saito Evidence-based risk factors for seroma formation in breast surgery. Jpn. J. Clin. Oncol., April 1, 2006; 36(4): 197 - 206. [Abstract] [Full Text] [PDF]

				I. C. Henderson Axillary Surgery: Clinical Judgment Required J. Clin. Oncol., January 20, 2006; 24(3): 325 - 326. [Full Text] [PDF]

				R. M. Morrell, M. Y. Halyard, S. E. Schild, M. S. Ali, L. L. Gunderson, and B. A. Pockaj Breast Cancer-Related Lymphedema Mayo Clin. Proc., November 1, 2005; 80(11): 1480 - 1484. [Abstract] [PDF]

				G. H. Lyman, A. E. Giuliano, M. R. Somerfield, A. B. Benson III, D. C. Bodurka, H. J. Burstein, A. J. Cochran, H. S. Cody III, S. B. Edge, S. Galper, et al. American Society of Clinical Oncology Guideline Recommendations for Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer J. Clin. Oncol., October 20, 2005; 23(30): 7703 - 7720. [Abstract] [Full Text] [PDF]