• Rana Hassan Javaid
  • Eitezaz Ahmed Bashir
  • Ahmed Waqas


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 Dissection


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


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


Carter CL, Allen C, Henson OF. Relation of tumour size, lymph

node status and survival in 24,740 breast cancer cases. Cancer


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


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


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


Singletary SE. Current status of axillary node

dissection. Contemp Surg 2002;58:334–40.