Long-Term Morbidity Following Axillary Dissection in Breast Cancer Patients – Clinical Assessment, Significance for Life Quality and the Impact of Demographic, Oncologic and Therapeutic Factors

Kuehn, Thorsten; Klauss, Wolfgang; Darsow, M; Regele, S; Flock, Felix; Maiterth, Christa; Dahlbender, Reiner W.; Wendt, Iris; Kreienberg, R.

doi:10.1023/a:1026564723698

Cited by 204 publications

(168 citation statements)

References 28 publications

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“…About 30 -40% of patients have positive axillary lymph nodes. The remaining 60 -70% of patients are lymph node negative and may therefore be overtreated with ALND, with the disadvantage of early and late complications as seroma, pain, limited arm motion, numbness or lymph oedema of the arm and breast (Kuehn et al, 2000). Sentinel lymph node biopsy is a minimally invasive surgical procedure with significant lower morbidity than ALND (Peintinger et al, 2003;Schijven et al, 2003).…”

Section: Discussionmentioning

confidence: 99%

200 Sentinel lymph node biopsies without axillary lymph node dissection – no axillary recurrences after a 3-year follow-up

Reitsamer

Peintinger²,

Prokop

et al. 2004

Br J Cancer

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The aim of this study is to evaluate the rate of axillary recurrences in sentinel lymph node (SLN)-negative breast cancer patients after sentinel lymph node biopsy (SLNB) alone without further axillary lymph node dissection (ALND). Between May 1999 and February 2002, 333 consecutive patients with primary invasive breast cancer up to 4 cm and clinically negative axillae were entered into this prospective study. Sentinel lymph nodes were identified using the combined method with blue dye (Patent blue V s ) and technetium 99m-labelled albumin (Nanocoll s ). Sentinel lymph nodes were examined by frozen sections, standard haematoxylin and eosin staining and immunohistochemistry staining. In SLN-positive patients, ALND was performed. Sentinel lymph node-negative patients had no further ALND. The SLN identification rate was 98.5% (328 out of 333). In all, 128 out of 328 (39.0%) patients had positive SLNs and complete ALND. A total of 200 out of 328 (61.0%) patients were SLN negative and had no further ALND. The mean tumour size of SLN-negative patients was 16.5 mm. The mean number of SLNs removed was 2.1 per patient. There were no local or axillary recurrences at a median follow-up of 36 months. The absence of axillary recurrences after SLNB without ALND in SLNnegative breast cancer patients supports the hypothesis that SLNB is accurate and safe while providing less surgical morbidity than ALND. Short-term results are very promising that SLNB without ALND in SLN-negative patients is an excellent procedure for axillary staging in a cohort of breast cancer patients with small tumours.

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Section: Discussionmentioning

confidence: 99%

200 Sentinel lymph node biopsies without axillary lymph node dissection – no axillary recurrences after a 3-year follow-up

Reitsamer

Peintinger²,

Prokop

et al. 2004

Br J Cancer

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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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“…Hack et al, showed arm/shoulder pain, weakness or numbness in 72% and impaired range of motion in 73% of breast cancer patients after ALND, whereas high levels of quality of life (QOL) were reported. Moderate to severe pain was reported between 20, 23 and 32% (Van Dam et al, 1993;Kuehn et al, 2000;Ververs et al, 2001) and was not significantly related to time since surgery. Other reports suggest that arm problems after ALND are associated with a negative effect on the overall QOL of breast cancer patients (Maunsell et al, 1993;Kuehn et al, 2000).…”

mentioning

confidence: 96%

“…Moderate to severe pain was reported between 20, 23 and 32% (Van Dam et al, 1993;Kuehn et al, 2000;Ververs et al, 2001) and was not significantly related to time since surgery. Other reports suggest that arm problems after ALND are associated with a negative effect on the overall QOL of breast cancer patients (Maunsell et al, 1993;Kuehn et al, 2000). As a result of the need to reduce axillary morbidity, many investigations have been performed on sentinel lymph node biopsy (SLNB), an alternative procedure.…”

mentioning

confidence: 96%

Comparison of quality of life and arm complaints after axillary lymph node dissection vs sentinel lymph node biopsy in breast cancer patients

Peintinger¹,

et al. 2003

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The sentinel lymph node biopsy (SLNB) represents a minimal invasive surgical method for axillary staging in patients with primary breast cancer. In a prospective study, evaluation of quality of life (QOL) and arm morbidity was performed before surgery on a total of 56 breast cancer patients. The EORTC QLQ-C30 and EORTC QLQ-BR23 questionnaires were used for QOL assessment. Assessment of pain was additionally observed using the McGill Pain Questionnaire. Arm mobility was observed by goniometric measurement of arm movement. Data were collected before surgery (t1), 1 week after discharge (t2) and 9 -12 months after surgery (t3). The type of axillary surgery does not seem to affect global QOL at a short-time follow-up, but patients recover sooner after SLNB. Body image and sexual functioning remain stable in both types of axillary surgery. Arm/shoulder pain was reported in 36% of patients after SLNB in comparison to 68% receiving axillary lymph node dissection (ALND), and 'numbness' was reported only in 4% of patients in the SLNB group vs 19.3% after ALND. Abduction, flexion and horizontal adduction of the affected arm show significant impairment after ALND. Breast cancer patients should be counselled about the benefits of SLNB over ALND concerning QOL and postsurgery side effects in a short-term follow-up. Axillary lymph node dissection (ALND) in breast cancer patients still represents the routine surgical method for axillary staging. Although the axillary node status is the most important prognostic factor for recurrence and survival (Fisher et al, 1984;Carter et al, 1989) and information obtained by axillary dissection is useful for planning adjuvant treatment, it is associated with substantial morbidity (Kissin et al, 1986;Ivens et al, 1992;Keramopoulos et al, 1993;Hack et al, 1999;Kakuda et al, 1999) and psychological distress (Maunsell et al, 1993;Tobin et al, 1993;Shimozuma et al, 1999). Hack et al, showed arm/shoulder pain, weakness or numbness in 72% and impaired range of motion in 73% of breast cancer patients after ALND, whereas high levels of quality of life (QOL) were reported. Moderate to severe pain was reported between 20, 23 and 32% (Van Dam et al, 1993;Kuehn et al, 2000;Ververs et al, 2001) and was not significantly related to time since surgery. Other reports suggest that arm problems after ALND are associated with a negative effect on the overall QOL of breast cancer patients (Maunsell et al, 1993;Kuehn et al, 2000). As a result of the need to reduce axillary morbidity, many investigations have been performed on sentinel lymph node biopsy (SLNB), an alternative procedure. Using vital dye and/or radiocolloid, the sentinel node/s as the first lymph node to receive lymphatic drainage from the primary tumour can be identified by a minimal invasive surgical technique. Recently, published data showed no sensory morbidity after SLNB (Giuliano et al, 2000) at a median follow-up of 39 months. Schrenk et al (2000) reported less postoperative arm pain, numbness and arm motion restriction after SLNB at a foll...

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Long-Term Morbidity Following Axillary Dissection in Breast Cancer Patients – Clinical Assessment, Significance for Life Quality and the Impact of Demographic, Oncologic and Therapeutic Factors

Cited by 204 publications

References 28 publications

200 Sentinel lymph node biopsies without axillary lymph node dissection – no axillary recurrences after a 3-year follow-up

200 Sentinel lymph node biopsies without axillary lymph node dissection – no axillary recurrences after a 3-year follow-up

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

Comparison of quality of life and arm complaints after axillary lymph node dissection vs sentinel lymph node biopsy in breast cancer patients

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