LONG-TERM MORBIDITY OF AXILLARY LYMPH NODE DISSECTION: IMPLICATIONS FOR PATIENTS WITH CARCINOMA BREAST
Abstract
Background: To assess the long term complications of level II Axillary Lymph Node Dissection(AXLND) in patients with breast cancer and to see if they are high enough to warrant a Sentinel LymphNode (SLN) biopsy in all patients presenting with carcinoma breast in our setup in Pakistan. Methods:This study was conducted at Surgical Unit IV, Department of Surgery, Combined Military Hospital,Rawalpindi. Upper, lower arm circumferences and body mass index were ascertained in post ModifiedRadical Mastectomy (MRM) with level II AXLND, in female patients who had undergone surgeriesfrom 1992 to 2008. Patient’s perception of degree of lymph oedema, arm function and other symptomslike pain, tingling and numbness was noted. The number of lymph nodes removed, number of positivenodes and post operative radiotherapy were also recorded from the hospital records. Results: Thusupper arm circumference in 85.7% patients and lower arm circumference in 89.2% patients was within2 Cm of the unaffected side. No, moderate and severe arm swelling was described by 83.35% ofpatients, 11.6% of patients and one patient respectively and 41.5% of patients describing some armswelling had positive lymph nodes. Thus even if they had gone (SLN) biopsy, these patients wouldhave had a subsequent AXLND. Over 94% of patients had either good or excellent arm function withmost in the excellent range. Conclusion: The patients at significant risk for positive nodal may bebetter served with an AXLND rather than the SLN technique.Keywords: Breast carcinoma, Sentinel lymph node biopsy, Axillary Lymph Node DissectionReferences
Wong SL, Abell TD, Chao C, Edwards MJ, McMasters KM.
Optimal use of sentinel node biopsy versus axillary node
dissection in patients with breast carcinoma: a decision analysis.
Cancer 2002;95:478–87.
Rashid M, Rafi CM, Mamoon N. Late presentation of carcinoma
breast in Pakistani women. Pak Armed Forces Med J
;46(2):11–5.
Nasir A, Nagi AH. Oestrogen receptor status and allied prognostic
indicators in breast cancer. Pak J Pathol 1990;1:37–44.
Abdullah P, Mubarik A, Zahir N, Rehman ZU, Sattar A,
Mehmood A. Breast lumps: what they actually represent. J Coll
Physicians Surg Pak 1998;9(1):46–8.
Malik IA, Mushtaq S, Khan AH, Mamoon N, Afzal S, Jamal S,
et al. A morphological study of 280 mastectomy specimens of
breast carcinoma. Pak J Pathol 1994;5(1):5–8.
Wahid Y, Mushtaq S, Khan AH, Malik IA, Mamoon N. A
morphological study of prognostic features in carcinoma breast.
Pak J Pathol 1998;9(2):9–13.
Kinne DW. Primary treatment of breast cancer. In: Harris JR,
Hellman S, Henderson IC. (eds). Breast Diseases, 2nd ed.
Philadelphia: JB Lippincott Co; 1987.
WHO. Physical status: the use and interpretation of
anthropometry. Report of a WHO Expert Committee. World
Health Organ Tech Rep Ser 1995;854:1–452.
Petrek JA, Senie RT, Peters M, Rosen PP. Lymphedema in a
cohort of breast carcinoma survivors 20 years after diagnosis.
Cancer 2001;92:1368–77.
Werner RS, McCormick B, Petrek JA, Cox L, Cirrincione
C, Gray JR, et al. Arm edema in conservatively managed breast
cancer: obesity is a major predictive factor. Radiology
;180:177–84.
Carter CL, Allen C, Henson OF. Relation of tumour size, lymph
node status and survival in 24,740 breast cancer cases. Cancer
;63:181–7.
Kurer HM, Wayne JD, Rose MI. Anaphylaxis during breast
cancer lymphatic mapping. Surgery 2001;129:119–20.
Leong SP, Donegan E, Heffemon W, Dean S, Katz JA. Adverse
reactions to isosulfan blue during selective sentinel lymph node
dissection in melanoma. Ann Surg Oncol 2000;7:361–6.
Ahmed N. Breast carcinoma in Pakistani women, how it differs
from the west. J Surg 1991;2:56–8.
Kayani MSB, Zaheer M, Ashraf N, Malik AM. Morbidity and
mortality in breast conservation surgery in early carcinoma
breast. Pak Armed Forces Med J 2008;58(3):253–9.
Khan MN, Jan MA, Shah S, Begum H, Khan SM. Breast
disease: Cause for delays in presentation. J Med Sci
;16(1):4–7.
Schlembach PJ, Buchholz TA, Ross MI, Kirsner SM, Salas
GJ, Strom EA, et al. Relationship of sentinel and axillary level III lymph nodes to tangential fields used in breast irradiation. Int J
Radiat Oncol Biol Phys 2001;51:671–8.
Veronesi U, Rilke F, Luini A, Sacchini V, Galimberti V, Campa
T, et al. Distribution of axillary node metastases by level of
invasion. An analysis of 539 cases. Cancer 1987;59:682–7.
Quiet CA, Ferguson DJ, Weichselbaum RR, Hellman S. Natural
history of node-positive breast cancer: the curability of small
cancers with a limited number of positive nodes. J Clin Oncol
;14:3105–11.
Overgaard M, Hansen PS, Overgaard J, Rose C, Andersson
M, Bach F, et al. Postoperative radiotherapy in high-risk
premenopausal women with breast cancer who receive adjuvant
chemotherapy. N Engl J Med 1997;337:949–55.
Ragaz J, Jackson SM, Le N, Plenderleith IH, Spinelli JJ, Basco
VE, et al. Adjuvant radiotherapy and chemotherapy in nodepositive premenopausal women with breast cancer. N Engl J Med
;337:956–62.
Singletary SE. Current status of axillary node
dissection. Contemp Surg 2002;58:334–40.
Published
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
