Prevalence of Lymphedema in Women With Breast Cancer 5 Years After Sentinel Lymph Node Biopsy or Axillary Dissection: Patient Perceptions and Precautionary Behaviors

Abstract

A B S T R A C T PurposeSentinel lymph node (SLN) 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. This study was undertaken to examine patient perceptions of lymphedema and use of precautionary behaviors several years after axillary surgery. Patients and MethodsNine hundred thirty-six women who underwent SLN biopsy (SLNB) alone or SLNB followed by axillary lymph node dissection (SLNB/ALND) between June 1, 1999, and May 30, 2003, were evaluated at a median of 5 years after surgery. Patient-perceived lymphedema and avoidant behaviors were assessed through interview and administered a validated instrument, and compared with arm measurements. ResultsCurrent arm swelling was reported in 3% of patients who received SLNB alone versus 27% of patients who received SLNB/ALND (P Ͻ .0001), as compared with 5% and 16%, respectively, with measured lymphedema. Only 41% of patients reporting arm swelling had measured lymphedema, and 5% of patients reporting no arm swelling had measured lymphedema. Risk factors associated with reported arm swelling were greater body weight (P Ͻ .0001), higher body mass index (P Ͻ .0001), infection (P Ͻ .0001), and injury (P ϭ .007) in the ipsilateral arm since surgery. Patients followed more precautions if they had measured or perceived lymphedema. ConclusionBody weight, infection, and injury are significant risk factors for perceiving lymphedema. There is significant discordance between the presence of measured and patient-perceived lymphedema. When compared to SLNB/ALND, SLNB-alone results in a significantly lower rate of patientperceived arm swelling 5 years postoperatively, and is perceived by fewer women than are measured to have it. J Clin

Distribution of Early-Stage Lymphedema and Risk Factors in Postoperative Patients with Breast Cancer: A Hospital Based Study

“…17,29,30 It is reported that the lymphedema frequency, which is recommended to be performed in axilla-negative cases today compared to AD. [31][32][33][34][35][36][37][38] In our study, RT treatment seemed to be one of the major factors that increased the lymphedema incidence. In the literature, even cases without surgical intervention with RT to the axilla showed increased lymphedema incidence; moreover, with the combination of AD, it is reported to increase the lymphedema risk even more by showing a synergistic effect.…”

The Perioperative Educational Program for Improving Upper Arm Dysfunction in Patients with Breast Cancer at 1-Year Follow-Up: A Prospective, Controlled Trial

“…Subjective symptom experience is the most important parameter for assessing physical function (Segerstrӧm et al 1991) and is often a major source of discomfort for patients (Petrek et al 2000). The more the patients perceive a certain symptom, the more likely they will behave to avoid that symptom (McLaughlin et al 2008). Our education program might have helped patients understand the symptoms related to breast surgery and made them check their symptoms in daily life.…”

“…The first author is a registered nurse and has been involved in education and research in breast nursing for more than 20 years. We used a pamphlet focusing on the etiology of upper arm dysfunction; the patients practiced the measurement of arm girth and assessment of 15 symptoms to identify changes in their arm; and they were also taught a risk minimization strategy (McLaughlin et al 2008) including a technique for lymphatic drainage of lymphedema and exercises for shoulder ROM. Telephone consultations were also provided.…”

Management of the positive axilla in 2017

“…AD, however, became an essential staging procedure enabling stratification of the patients to the appropriate adjuvant treatment. This procedure, however, also exposes 78% of early stage breast cancer patients to overtreatment with a 16% risk of lymphedema in five years [8]. With the appearance of the lymphatic mapping technique, three seminal studies, MILAN, NSABP-B32, and ALMANAC trials established sentinel lymph node biopsy (SLNB), a much less invasive procedure, as the new standard for staging of the axilla [9][10][11][12].…”

“…Although SLNB is a minimally invasive procedure it is still associated with some morbidity including a risk of lymphedema amounting to five percent at five years [8]. The SOUND trial at the European Institute of Oncology is investigating whether ultrasound staging of the axilla could substitute SLNB.…”