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Surgical Complications Associated With Sentinel Lymph Node Biopsy: Results From a Prospective International Cooperative Group Trial

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Abstract

Background

American College of Surgeons Oncology Group Z0010 is a prospective multicenter trial designed to evaluate the prognostic significance of micrometastases in the sentinel lymph nodes and bone marrow aspirates of women with early-stage breast cancer. Surgical complications associated with the sentinel lymph node biopsy surgical procedure are reported.

Methods

Eligible patients included women with clinical T1/2N0M0 breast cancer. Surgical outcomes were available at 30 days and 6 months after surgery for 5327 patients. Patients who had a failed sentinel node mapping (n = 71, 1.4%) or a completion lymph node dissection (n = 814, 15%) were excluded. Univariate and multivariate analyses were performed to identify predictors for the measured surgical complications.

Results

In patients who received isosulfan blue dye alone (n = 783) or a combination of blue dye and radiocolloid (n = 4192), anaphylaxis was reported in .1% of subjects (5 of 4975). Other complications included axillary wound infection in 1.0%, axillary seroma in 7.1%, and axillary hematoma in 1.4% of subjects. Only increasing age and an increasing number of sentinel lymph nodes removed were significantly associated with an increasing incidence of axillary seroma. At 6 months, 8.6% of patients reported axillary paresthesias, 3.8% had a decreased upper extremity range of motion, and 6.9% demonstrated proximal upper extremity lymphedema (change from baseline arm circumference of >2 cm). Significant predictors for surgical complications at 6 months were a decreasing age for axillary paresthesias and increasing body mass index and increasing age for upper extremity lymphedema.

Conclusions

This study provides a prospective assessment of the sentinel lymph node biopsy procedure, as performed by a wide range of surgeons, demonstrating a low complication rate.

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References

  1. Giuliano AE, Kirgan DM, Guenther JM, Morton DL. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg 1994; 220:391–401

    CAS  PubMed  Google Scholar 

  2. Krag D, Weaver D, Ashikaga T, et al. The sentinel node in breast cancer—a multicenter validation study. N Engl J Med 1998; 339:941–6

    Article  CAS  PubMed  Google Scholar 

  3. Tafra L, Lannin D, Swanson M, et al. Multicenter trial of sentinel node biopsy for breast cancer using both technetium sulfur colloid and isosulfan blue dye. Ann Surg 2001; 233:51–9

    CAS  PubMed  Google Scholar 

  4. Shivers S, Cox C, Leight G, et al. Final results of the Department of Defense multicenter breast lymphatic mapping trial. Ann Surg Oncol 2002; 9:248–55

    Article  PubMed  Google Scholar 

  5. Veronesi U, Paganelli G, Viale G, et al. Sentinel lymph node biopsy and axillary dissection in breast cancer: results in a large series. J Natl Cancer Inst 1999; 91:368–73

    CAS  PubMed  Google Scholar 

  6. Morrow M, Rademaker AW, Bethke KP, et al. Learning sentinel node biopsy: results of a prospective randomized trial of two techniques. Surgery 1999; 126:714–22

    CAS  PubMed  Google Scholar 

  7. Bergkvist L, Frisell J, Liljegren G, Celebioglu F, Damm S, Thorn M. Multicentre study of detection and false-negative rates in sentinel node biopsy for breast cancer. Br J Surg 2001; 88:1644–8

    Article  CAS  PubMed  Google Scholar 

  8. McMasters KM, Tuttle TM, Carlson DJ, et al. Sentinel lymph node biopsy for breast cancer: a suitable alternative to routine dissection in multi-institutional practice when optimal technique is used. J Clin Oncol 2000; 18:1644–8

    Google Scholar 

  9. Cody HS, Fey J, Akhurst T, et al. Complementarity of blue dye and isotope in sentinel node localization for breast cancer: univariate and multivariate analysis of 966 procedures. Ann Surg Oncol 2001; 8:13–9

    PubMed  Google Scholar 

  10. Kelley MC, Hansen N, McMasters KM. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Am J Surg 2004; 188:49–61

    Article  PubMed  Google Scholar 

  11. Giuliano AE, Haigh PI, Breannan MB, et al. Prospective observational study of sentinel lymphadenectomy without further axillary dissection in patients with sentinel node-negative breast cancer. J Clin Oncol 2000; 18:2553–9

    CAS  PubMed  Google Scholar 

  12. Meric F, Buchholz TA, Mirza NQ, et al. Long-term complications associated with breast-conservation surgery and radiotherapy. Ann Surg Oncol 2002; 9:543–9

    Article  PubMed  Google Scholar 

  13. Gervasoni JE, Charu T, Chung MA, Cady B. Axillary dissection in the context of the biology of lymph node metastases. Am J Surg 2000; 180:278–83

    Article  PubMed  Google Scholar 

  14. Rietman JS, Dijkstra PU, Geertzen JH, et al. Short-term morbidity of the upper limb after sentinel lymph node biopsy or axillary lymph node dissection for stage I or II breast carcinoma. Cancer 2003; 98:690–6

    Article  PubMed  Google Scholar 

  15. Veronesi U, Paganelli G, Viale G, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med 2003; 349:546–53

    Article  PubMed  Google Scholar 

  16. Smith RA, Duffy SW, Gabe R, et al. The randomized trials of breast cancer screening: what have we learned? Radiol Clin North Am 2004; 42:793–806

    Article  PubMed  Google Scholar 

  17. Ozaslan C, Kuru B. Lymphedema after treatment of breast cancer. Am J Surg 2004; 187:69–72

    Article  PubMed  Google Scholar 

  18. Rampaul RS, Mullinger K, Macmillan RD, et al. Incidence of clinically significant lymphoedema as a complication following surgery for primary operable breast cancer. Eur J Cancer 2003; 39:2165–7

    Article  CAS  PubMed  Google Scholar 

  19. Thomson AM, Air M, Jack WJL, et al. Arm morbidity after breast conservation and axillary therapy. Breast 1995; 4:273–6

    Google Scholar 

  20. Liljegren G, Holmberg L. Arm morbidity after sector resection and axillary dissection with or without postoperative radiotherapy in breast cancer stage I. Results from a randomised trial. Eur J Cancer 1997; 33:193–9

    Article  CAS  PubMed  Google Scholar 

  21. Warmuth MA, Bowen G, Prosnitz LR, et al. Complications of axillary lymph node dissection for carcinoma of the breast: a report based on a patient survey. Cancer 1998; 83:1362–8

    Article  CAS  PubMed  Google Scholar 

  22. Kuehn T, Klauss W, Darsow M, et al. 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. Breast Cancer Res Treat 2000; 64:275–86

    Article  CAS  PubMed  Google Scholar 

  23. Mansel RE, Goyal A, Fallowfield L, et al. Sentinel node biopsy versus standard axillary treatment: results of the randomized multicenter UK ALMANAC trial. Breast Cancer Res Treat 2004; 88:S13

    Google Scholar 

  24. Julian TB, Krag D, Brown A, et al. Preliminary technical results of NSABP B-32, a randomized phase III clinical trial to compare sentinel node resection to conventional axillary dissection in clinically node-negative breast cancer patients. Breast Cancer Res Treat 2004; 88:S11

    Google Scholar 

  25. Newman LA. Lymphatic mapping and sentinel lymph node biopsy in breast cancer patients: a comprehensive review of variations in performance and technique. J Am Coll Surg 2004; 199:804–16

    PubMed  Google Scholar 

  26. Montgomery LL, Thorne AC, Van Zee KJ, et al. Isosulfan blue dye reactions during sentinel lymph node mapping for breast cancer. Anesth Analg 2002; 95:385–8

    PubMed  Google Scholar 

  27. Cimmino VM, Brown AC, Szocik JF, et al. Allergic reactions to isosulfan blue during sentinel node biopsy—a common event. Surgery 2001; 130:439–42

    Article  CAS  PubMed  Google Scholar 

  28. Albo D, Wayne JD, Hunt KK, et al. Anaphylactic reactions to isosulfan blue dye during sentinel lymph node biopsy for breast cancer. Am J Surg 2001; 182:393–8

    Article  CAS  PubMed  Google Scholar 

  29. Efron P, Knudsen E, Hirshorn S, Copeland EM. Anaphylactic reaction to isosulfan blue used for sentinel node biopsy: case report and literature review. Breast J 2002; 8:396–9

    Article  PubMed  Google Scholar 

  30. Bold RJ, Mansfield PF, Berger DH, et al. Prospective, randomized, double-blind study of prophylactic antibiotics in axillary lymph node dissection. Am J Surg 1998; 176:239–43

    Article  CAS  PubMed  Google Scholar 

  31. Rotstein C, Ferguson R, Cummings KM, et al. Determinants of clean surgical wound infections for breast procedures at an oncology center. Infect Control Hosp Epidemiol 1992; 13:207–14

    CAS  PubMed  Google Scholar 

  32. Lin PP, Allison DC, Wainstock J, et al. Impact of axillary lymph node dissection on the therapy of breast cancer patients. J Clin Oncol 1993; 11:1536–44

    CAS  PubMed  Google Scholar 

  33. Petrek JA, Peters MM, Nori S, et al. Axillary lymphadenectomy: a prospective randomized trial of thirteen factors influencing drainage, including early or delayed arm mobilization. Arch Surg 1990; 125:378–82

    CAS  PubMed  Google Scholar 

  34. Gonzalez EA, Saltzstein EC, Riedner CS, et al. Seroma formation following breast cancer surgery. Breast J 2003; 9:385–8

    Article  PubMed  Google Scholar 

  35. Zavotsky, Jones RC, Brennan MB, Giuliano AE. Evaluation of axillary lymphadenectomy without axillary drainage for patients undergoing breast-conserving therapy. Ann Surg Oncol 1998; 5:227–31.

    Article  CAS  PubMed  Google Scholar 

  36. Burak WE Jr, Goodman PS, Young DC, et al. Seroma formation following axillary dissection for breast cancer: risk factors and lack of influence of bovine thrombin. J Surg Oncol 1997; 64:27–31

    Article  CAS  PubMed  Google Scholar 

  37. Jeffrey SS, Goodson WH, Ikeda DM, et al. Axillary lymphadenectomy for breast cancer without axillary drainage. Arch Surg 1995; 130:909–13

    CAS  PubMed  Google Scholar 

  38. Roses DF, Brooks AD, Harris MN, et al. Complications of level I and II axillary dissection in the treatment of carcinoma of the breast. Ann Surg 1999; 230:194–201

    Article  CAS  PubMed  Google Scholar 

  39. Burak WE, Hollenbeck ST, Zervos EE, et al. Sentinel lymph node biopsy results in less postoperative morbidity compared with axillary lymph node dissection for breast cancer. Am J Surg 2002; 183:23–7

    Article  PubMed  Google Scholar 

  40. Schrenk P, Rieger R, Shamiyeh A, et al. Morbidity following sentinel lymph node biopsy versus axillary lymph node dissection for patients with breast carcinoma. Cancer 2000; 88:608–14

    Article  CAS  PubMed  Google Scholar 

  41. Kakuda JT, Stuntz M, Trivedi V, et al. Objective assessment of axillary morbidity in breast cancer treatment. Am Surg 1999; 65:995–8

    CAS  PubMed  Google Scholar 

  42. Stotter A, Chandler T. Breast cancer: outcome audit of axillary management in 1991. Eur J Surg Oncol 1999; 25:261–4

    CAS  PubMed  Google Scholar 

  43. Keramopoulos A, Tsionou C, Minaretzis D, et al. Arm morbidity following treatment of breast cancer with total axillary dissection: a multivariated approach. Oncology 1993; 50:445–9

    CAS  PubMed  Google Scholar 

  44. Swenson KK, Nissen MJ, Ceronsky C, et al. Comparison of side effects between sentinel lymph node and axillary lymph node dissection for breast cancer. Ann Surg Oncol 2002; 9:745–53

    Article  PubMed  Google Scholar 

  45. Krynyckyi BR, Shim J, Lim I. Short-term morbidity of the upper limb after sentinel lymph node biopsy or axillary lymph node dissection for stage I or II breast carcinoma (letter). Cancer 2004; 101:2367–8

    Article  PubMed  Google Scholar 

  46. Mansel RE, Goyal A, Newcombe RG, et al. Objective assessment of lymphedema, shoulder function and sensory deficit after sentinel node biopsy for invasive breast cancer: ALMANAC trial. Breast Cancer Res Treat 2004; 88:S12.

    Google Scholar 

  47. Kissin MW, della Rovere QG, Easton D, Westbury G. Risk of lymphedema following the treatment of breast cancer. Br J Surg 1986; 73:580–4

    CAS  PubMed  Google Scholar 

  48. Delouche G, Bachelot F, Premont M, Kurtz JM. Conservation treatment of early breast cancer: long term results and complications. Int J Radiat Oncol Biol Phys 1987; 13:29–34

    CAS  PubMed  Google Scholar 

  49. Larson D, Weinstein M, Goldberg I, et al. Edema of the arm as a function of the extent of axillary surgery in patients with stage I-II carcinoma of the breast treated with primary radiotherapy. Int J Radiat Oncol Biol Phys 1986; 12:1575–82

    CAS  PubMed  Google Scholar 

  50. Petrek JA, Senie RT, Peters M, et al. Lymphedema in a cohort of breast carcinoma survivors 20 years after diagnosis. Cancer 2001; 92:1368–77

    Article  CAS  PubMed  Google Scholar 

  51. Passik SD, McDonald MV. Psychosocial aspects of upper extremity lymphedema in women treated for breast carcinoma. Cancer 1998; 83:2817–20

    Article  CAS  PubMed  Google Scholar 

  52. Tobin MB, Lacey HJ, Meyer L, Mortimer PS. The psychosocial morbidity of breast cancer-related arm swelling. Psychological morbidity of lymphoedema. Cancer 1993; 72:3248–52

    CAS  PubMed  Google Scholar 

  53. Velanovich V, Szymanski W. Quality of life of breast cancer patients with lymphedema. Am J Surg 1999; 177:184–7

    Article  CAS  PubMed  Google Scholar 

  54. Kwan W, Jackson J, Weir LM, et al. Chronic arm morbidity after curative breast cancer treatment: prevalence and impact on quality of life. J Clin Oncol 2002; 20:4242–8

    Article  PubMed  Google Scholar 

  55. Silberman AW, McVay C, Cohen JS, et al. Comparative morbidity of axillary lymph node dissection and the sentinel lymph node technique: implications for patients with breast cancer. Ann Surg 2004; 240:1–6

    PubMed  Google Scholar 

  56. Sener SF, Winchester DJ, Martz CH, et al. Lymphedema after sentinel lymphadenectomy for breast carcinoma. Cancer 2001; 92:748–52

    Article  CAS  PubMed  Google Scholar 

  57. Haid A, Köberle-Wührer R, Knauer M, et al. Morbidity of breast cancer patients following complete axillary dissection or sentinel node biopsy only: a comparative evaluation. Breast Cancer Res Treat 2002; 73:31–6

    Article  PubMed  Google Scholar 

  58. Werner RS, McCormick B, Petrek JA, et al. Arm edema in conservatively managed breast cancer: obesity is a major predictive factor. Radiology 1991; 180:177–84

    CAS  PubMed  Google Scholar 

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Acknowledgments

The authors thank all the participating surgeons and patients of ACOSOG Z0010 and Samuel A. Wells, Jr., MD, for his support in developing and bringing ACOSOG Z0010 to completion.

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Authors and Affiliations

  1. Department of Surgery, Duke University Medical Center, Durham, North Carolina

    Lee Gravatt Wilke MD & Katherine E. Posther MD

  2. American College of Surgeons Oncology Group, Duke University Medical Center, Durham, North Carolina

    Linda M. McCall MS & James E. Herndon II PhD

  3. Nashville Breast Center, Nashville, Tennessee

    Pat W. Whitworth MD

  4. Lakeland Regional Cancer Center, Lakeland, Florida

    Douglas S. Reintgen MD

  5. Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas

    A. Marilyn Leitch MD

  6. Department of Surgery, Emory University School of Medicine, Atlanta, Georgia

    Sheryl G. A. Gabram MD

  7. Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas

    Anthony Lucci MD & Kelly K. Hunt MD

  8. Department of Surgical Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida

    Charles E. Cox MD

  9. Department of Surgical Oncology, John Wayne Cancer Institute, 2200 Santa Monica Boulevard, Santa Monica, 90404, California

    Armando E. Giuliano MD

Authors
  1. Lee Gravatt Wilke MD
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  2. Linda M. McCall MS
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  3. Katherine E. Posther MD
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  5. Douglas S. Reintgen MD
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  6. A. Marilyn Leitch MD
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  7. Sheryl G. A. Gabram MD
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  8. Anthony Lucci MD
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  9. Charles E. Cox MD
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  10. Kelly K. Hunt MD
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  11. James E. Herndon II PhD
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  12. Armando E. Giuliano MD
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Corresponding author

Correspondence to Armando E. Giuliano MD.

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Wilke, L.G., McCall, L.M., Posther, K.E. et al. Surgical Complications Associated With Sentinel Lymph Node Biopsy: Results From a Prospective International Cooperative Group Trial. Ann Surg Oncol 13, 491–500 (2006). https://doi.org/10.1245/ASO.2006.05.013

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  • DOI: https://doi.org/10.1245/ASO.2006.05.013

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