Comparative Morbidity of Axillary Lymph Node Dissection and the Sentinel Lymph Node Technique

Silberman, Allan W.; McVay, Carie; Cohen, Jason; Altura, Jack F.; Brackert, Sandra; Sarna, G; Palmer, Daphne; Ko, Albert; Memsic, Leslie

doi:10.1097/01.sla.0000129358.80798.62

Cited by 74 publications

(43 citation statements)

References 20 publications

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“…Although it is clear that ALND provides no therapeutic benefit to patients with histologically negative nodes and exposes patients to significant potential morbidity, some have advocated ALND as the optimum surgical procedure which is the ''gold standard'' for staging the axilla [16]. These concerns have been raised by the finding of false negative rates of 5-10% for SNB when followed by axillary dissection, and have caused some to question its appropriateness in patients at high risk for axillary nodal disease.…”

Section: Discussionmentioning

confidence: 99%

Outcome of axillary staging in early breast cancer: a meta-analysis

Kell

Burke

Barry

et al. 2010

Breast Cancer Res Treat

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Axillary lymph node dissection (ALND) is associated with significant morbidity, whilst sentinel node biopsy (SNB) has the potential to minimize complications in the management of breast cancer. The aim of this study was to systematically appraise the outcome of SNB when compared to ALND. A comprehensive search for published trials examining outcomes after SNB for breast cancer was performed using medline and cross-referencing available data. Each study was reviewed and data extracted. Primary outcomes were nodal positivity and surgery-related morbidity. A total of 9,608 patients were identified from trials comparing ALND and SNB. The overall rate of axillary lymph node positivity for those with no clinically palpable nodes was 28.8% for ALND and 27.6% for SNB (OR = 1.00, 95% CI = 0.86-1.17, P = 0.956), though there was a trend for superior detection of metastatic disease with SNB when this was compared with ALND alone (OR = 1.22, 95% CI = 0.95-1.57, P = 0.122). Patients who undergo SNB are significantly less likely to suffer post-operative morbidity relative to ALND: risk of infection (OR = 0.58, 95% CI = 0.42-0.80, P = 0.0011), seroma (OR = 0.40, 95% CI = 0.31-0.51, P = 0.0071), arm swelling (OR = 0.30, 95% CI = 0.14-0.66, P = 0.0028) and numbness (OR = 0.25, 95% CI = 0.1-0.59, P = 0.0018).SNB is at least equivalent to ALND in detecting metastatic disease in the axilla. SNB is the optimum approach in terms of morbidity for the assessment of axillary metastasis in clinically node negative breast cancer.

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Section: Discussionmentioning

confidence: 99%

Outcome of axillary staging in early breast cancer: a meta-analysis

Kell

Burke

Barry

et al. 2010

Breast Cancer Res Treat

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“…The SN biopsy has therefore reduced the morbidity associated with axillary lymph node dissection (ALND) and has readily evolved into the standardized staging procedure in clinically node negative breast cancer patients (Veronesi et al 1999;Golshan et al 2003;Lyman et al 2005;Ferrari et al 2006). For instance, previous studies demonstrated that morbidity of ALND including lymphedema, arm paresthesia, chronic pain and immobility occurs in 5% to 50% of the patients (Kuehn et al 2000;Petrek et al 2001;Silberman et al 2004;Wilke et al 2006). In addition, SN biopsy is an acceptable procedure alterative to ALND for staging the axillary lymph node status in patients with early stage breast cancer (Lyman et al 2005).…”

Section: Introductionmentioning

confidence: 99%

Non-Invasive Evaluation of Axillary Lymph Node Status in Breast Cancer Patients Using Shear Wave Elastography

Tamaki¹,

Tamaki²,

Kamada³

et al. 2013

Tohoku J. Exp. Med.

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Less invasive procedures are currently required to examine the axillary lymph node status. Shear wave elastography with acoustic radiation force impulse provides objective and reproducible quantification of the intrinsic property of the soft tissue. In this study, we measured shear wave velocity of the axillary lymph nodes of patients with breast cancer using Virtual Touch Tissue Quantification (VTTQ). The degree of lymph node metastasis was evaluated by measuring the expression level of cytokeratin 19 (CK19) mRNA, a specific marker for breast cancer cells. The one-step nucleic acid amplification (OSNA) was used to determine the copy number of CK19 mRNA in 149 lymph node specimens of 149 primary breast cancer patients. Axillary lymph node status according to OSNA (copy number/μl) were categorized as 0-249 copies (−), 250-5,000 copies (+), and copy number > 5,000 (++). A category (−) represents no metastasis in the axillary lymph node. There were 121 patients with OSNA−, 9 with OSNA+ and 19 with OSNA++. The average velocities according to OSNA categories were 1.64 ± 0.42 m/second for OSNA−, 2.25 ± 0.78 m/second for OSNA+, and 2.79 ± 0.98 m/second for OSNA++. There were significant differences in the shear wave velocity between OSNA− and OSNA+ (P = 0.040) or OSNA++ (P < 0.001). The most optimal cutoff velocity to distinguish benign from metastasis is 1.44 m/second, as determined using the receiver operating characteristic method. The shear wave velocity measured with VTTQ could provide clinically useful information about axillary lymph node metastasis in patients with primary breast cancer.

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“…14 In contrast to this research, current reports of incidence with SNLB has been 0 -23%. 5,10,12 ALND 5,15,18,21,22,[23][24][25][26] and radiotherapy 8,14,25,27,28 are thought to be contributing factors for SLE. However, lack of consensus occurs regarding which risk factors contribute consistently to SLE.…”

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confidence: 99%

“…However, lack of consensus occurs regarding which risk factors contribute consistently to SLE. 8,14,24 Other factors that may increase the risk for developing SLE are body mass index (BMI), 14,29,30 dominant arm, 31,32 age, 33 weight gain/obesity, 5,11,13,29,33 staging, 10,34 number of lymph nodes removed, 29 medical therapies, 35,36 and infection. 10,13 …”

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confidence: 99%

Psychologic and social sequelae of secondary lymphedema

McWayne

Heiney

2005

Cancer

201

114

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Objective Human immunodeficiency virus (HIV) infection of the central nervous system (CNS) is frequently associated with intrathecal immunoglobulin synthesis and cerebrospinal fluid (CSF) pleocytosis, but little is known about the B‐cell response in the CSF of these patients. In this study, we investigated the relation between virus load and the frequency and phenotype of B cells in the CSF of HIV‐infected patients. Methods The distribution of T cells, B cells, short‐lived plasmablasts, and long‐lived plasma cells was analyzed by flow cytometry in CSF and peripheral blood of 33 patients with HIV infection compared with 12 patients with noninfectious CNS diseases. HIV RNA copy number in CSF and serum was quantified by kinetic polymerase chain reaction. Results B‐cell and plasmablast levels were increased in the CSF of HIV‐infected patients compared with patients with noninfectious CNS diseases. Whereas CSF B cells were found at similar frequency during early and late stages of HIV infection, plasmablasts were more prevalent in the CSF during early infection. Plasmablasts in the CSF correlated with intrathecal IgG synthesis and even stronger with HIV RNA copy numbers in CSF, in particular, in untreated, early HIV‐infected individuals. Initiation of antiviral treatment in therapy‐naive patients strongly decreased HIV copy numbers and plasmablasts in CSF. Interpretation Our findings demonstrate that HIV infection of the CNS triggers an early profound B‐cell response, with plasmablasts serving as the main virus‐related B‐cell subset in the CSF. Ann Neurol 2007

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Comparative Morbidity of Axillary Lymph Node Dissection and the Sentinel Lymph Node Technique

Abstract: Our data indicate that a complete AXLND can be performed with minimal long-term morbidity. The lower the morbidity of AXLND, the less acceptable are the unique complications of the SLN technique.

Cited by 74 publications

References 20 publications

Outcome of axillary staging in early breast cancer: a meta-analysis

Outcome of axillary staging in early breast cancer: a meta-analysis

Non-Invasive Evaluation of Axillary Lymph Node Status in Breast Cancer Patients Using Shear Wave Elastography

Psychologic and social sequelae of secondary lymphedema

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