Originally published as JCO Early Release 10.1200/JCO.2008.16.3725 on October 6 2008

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Prevalence of Lymphedema in Women With Breast Cancer 5 Years After Sentinel Lymph Node Biopsy or Axillary Dissection: Objective Measurements

Sarah A. McLaughlin, Mary J. Wright, Katherine T. Morris, Gladys L. Giron, Michelle R. Sampson, Julia P. Brockway, Karen E. Hurley, Elyn R. Riedel, Kimberly J. Van Zee

From the Breast Service, Department of Surgery; Behavioral Science Service, Department of Psychiatry and Behavioral Science; and the Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY

Corresponding author: Kimberly J. Van Zee, MS, MD, 1275 York Ave, MRI 1026, New York, NY 10065; e-mail: vanzeek{at}mskcc.org

Purpose 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).

Patients and 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.

Conclusion 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.

published online ahead of print at www.jco.org on October 6, 2008.

Supported by National Cancer Institute Grant No. K07 CA109236 (K.E.H.).

Presented in part at the 60th Annual Cancer Symposium of the Society of Surgical Oncology, March 15-18, 2007, Washington, DC, and at the American Society of Clinical Oncology Breast Symposium, September 7-8, 2007, San Francisco, CA.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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