Lymph-Oedema More Common Than Realised After Sentinel Lymph-Node Dissection: Presented at SSO

By Nancy A. Melville

PHOENIX, Arizona -- March 17, 2014 -- Lymph-oedema after sentinel lymph-node dissection occurs more commonly than previously expected, and increases with time among women treated for early-stage breast cancer, according to researchers at the 67th Annual Cancer Symposium of the Society of Surgical Oncology (SSO).

A previous prospective, multicentre study from the American Society of Surgeons Oncology Group (ACOSOG) demonstrated an incidence of lymph-oedema of 7% at 6 months after sentinel lymph-node dissection in women with early-stage breast cancer. The study was undertaken to evaluate the prognostic significance of micrometastasis. Eligible patients included women with clinical T1-2 N0 M0 breast cancer.

Following up on the longer-term incidence of lymph-oedema in the same cohort, researchers compared 5,210 women who underwent sentinel-node dissection with 885 who had complete axillary lymph-node dissection.

The cumulative incidence of lymph-oedema after sentinel lymph-node dissection was 3.7% at 1 year, 8.9% at 3 years, and 11.9% at 5 years by subjective assessment (n = 3,993), stated lead author Mediget Teshome, MD, University of Texas M.D. Anderson Cancer Center, Houston, Texas, speaking here on March 14. The incidence by objective arm measurements (n = 3,918) was 10.5% at 1 year, 17.4% at 3 years, and 24.1% at 5 years.

Following axillary lymph-node dissection, the incidence of lymph-oedema was 14.0% at 1 year, 32.9% at 3 years, and 41.0% at 5 years by subjective assessment (n = 865), and was 17.0% at 1 year, 30.6% at 3 years, and 40.3% at 5 years by objective arm measurement (n = 853).

The strongest predictors of objective lymph-oedema, according to multivariate analysis, were increasing age (odds ratio [OR] = 1.01, 95% confidence interval [CI]: 1.01 to 1.02, P< .0001); body mass index ≥ 30 (OR = 1.81, CI: 1.59 to 2.06, P< .0001); and axillary lymph-node dissection (OR = 1.74, CI: 1.50 to 2.02, P< .0001).

Reports of decreased range of motion and paraesthesias were more common than lymph-oedema after axillary surgery.

“We found a 24.1% cumulative incidence of lymph-oedema at 5 years after sentinel lymph-node dissection, with increases in lymph-oedema at each assessment varying from 6.5% to 9.2%,” said Dr. Teshome.

“This occurrence is more frequent than clinically suspected,” Dr. Teshome added. “Populations at risk include patients who are older, obese, and require completion axillary lymph-node dissection.”

Dr. Teshome speculated that the higher incidence may be explained by improvement in symptoms over time, secondary to interventions. “Further directions include assessment of the severity of lymph-oedema after sentinel lymph-node dissection and evaluation of patient education, prevention efforts, and treatment strategies for lymph-oedema,” she concluded.

[Presentation title: Long-Term Incidence of Lymphedema After Sentinel Lymph Node
Dissection for Early Stage Breast Cancer: ACOSOG Z0010
(Alliance). Abstract #3]

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