Helen Ballal1, Catherine Hunt1, Chrianna Bharat2, Kevin Murray3, Roshi Kamyab1, Christobel Saunders4. 1. Breast Unit, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia. 2. National Drug and Alcohol Research Centre, The University of New South Wales, Sydney, New South Wales, Australia. 3. School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia. 4. Division of Surgery, Medical School, The University of Western Australia, Perth, Western Australia, Australia.
Abstract
BACKGROUND: Staging of axillary lymph nodes in breast cancer is important for prognostication and planning of adjuvant therapy. The traditional practice of proceeding to axillary lymph node dissection (ALND) if sentinel lymph node biopsy (SLNB) is positive is being challenged and clinical trials are underway. For many centres, this will mean a move away from intra-operative SLNB assessment and utilization of a second procedure to perform ALND. It is sometimes perceived that a delayed ALND results in increased tissue damage and thus increased morbidity. We compared morbidity in those undergoing SLNB only, or ALND as a one- or two-stage procedure. METHODS: A retrospective review of a prospectively collected institutional database was used to review rates of lymphoedema and shoulder function in women undergoing breast cancer surgery between 2008 and 2012. RESULTS: The overall lymphoedema rate in 745 patients was 8.2% at 12 months. There was no difference in lymphoedema rates between those undergoing immediate or delayed ALND (17.8 and 8.6%, respectively, P = 0.092). Post-operative shoulder elevation, odds ratio (OR) = 0.390, 95% confidence interval (CI) = (0.218, 0.698) and abduction, OR = 0.437 (95% CI = (0.271, 0.705)) were reduced if an ALND was performed although there was no difference between immediate or delayed. CONCLUSION: ALND remains a risk factor for post-operative morbidity. There is no increased risk of lymphoedema or shoulder function deficit with a positive SLNB and delayed ALND compared to immediate ALND.
BACKGROUND: Staging of axillary lymph nodes in breast cancer is important for prognostication and planning of adjuvant therapy. The traditional practice of proceeding to axillary lymph node dissection (ALND) if sentinel lymph node biopsy (SLNB) is positive is being challenged and clinical trials are underway. For many centres, this will mean a move away from intra-operative SLNB assessment and utilization of a second procedure to perform ALND. It is sometimes perceived that a delayed ALND results in increased tissue damage and thus increased morbidity. We compared morbidity in those undergoing SLNB only, or ALND as a one- or two-stage procedure. METHODS: A retrospective review of a prospectively collected institutional database was used to review rates of lymphoedema and shoulder function in women undergoing breast cancer surgery between 2008 and 2012. RESULTS: The overall lymphoedema rate in 745 patients was 8.2% at 12 months. There was no difference in lymphoedema rates between those undergoing immediate or delayed ALND (17.8 and 8.6%, respectively, P = 0.092). Post-operative shoulder elevation, odds ratio (OR) = 0.390, 95% confidence interval (CI) = (0.218, 0.698) and abduction, OR = 0.437 (95% CI = (0.271, 0.705)) were reduced if an ALND was performed although there was no difference between immediate or delayed. CONCLUSION: ALND remains a risk factor for post-operative morbidity. There is no increased risk of lymphoedema or shoulder function deficit with a positive SLNB and delayed ALND compared to immediate ALND.
Authors: Richard Ha; Peter Chang; Jenika Karcich; Simukayi Mutasa; Reza Fardanesh; Ralph T Wynn; Michael Z Liu; Sachin Jambawalikar Journal: J Digit Imaging Date: 2018-12 Impact factor: 4.056
Authors: Wen Ling Choong; Andrew Evans; Colin A Purdie; Huan Wang; Peter T Donnan; Brooke Lawson; E Jane Macaskill Journal: Br J Radiol Date: 2020-01-28 Impact factor: 3.039
Authors: Chirag Shah; April Zambelli-Weiner; Nicole Delgado; Ashley Sier; Robert Bauserman; Jerrod Nelms Journal: Breast Cancer Res Treat Date: 2020-11-27 Impact factor: 4.872