Lymphedema after sentinel lymphadenectomy for breast carcinoma

BACKGROUND. Initial studies of sentinel lymphadenectomy for patients with b reast carcinoma confirmed that the status of the sentinel lymph nodes was a n accurate predictor of the presence of metastatic disease in the axillary lymph nodes. Sentinel lymphadenectomy, as an axillary staging procedure, ha s risks of morbidity that have yet to be defined. METHODS. Patients were enrolled in a two-phase protocol that included concu rrent data collection of patient characteristics and treatment variables. D uring the first (validation) phase, 72 patients underwent sentinel lymph no de excision followed by a level I-II axillary dissection. After the techniq ue had been established, the second phase commenced, during which only pati ents with positive sentinel lymph nodes underwent an axillary dissection. RESULTS. During the second phase, lymphedema was identified in 9 of 303 pat ients (3.0%) who underwent sentinel lymphadenectomy alone and in 20 of 117 patients (17.1%) who underwent sentinel lymphadenectomy combined with axill ary dissection (P < 0.0001). Of 303 patients who underwent sentinel lymphad enectomy alone, 8 of 155 patients (5.1%) with tumors located in the upper o uter quadrant and 1 of 148 patients (0.7%) with tumors in other locations d eveloped lymphedema (P = 0.012). CONCLUSIONS. The risk of developing lymphedema after undergoing sentinel ly mphadenectomy was measurable but significantly lower than after undergoing axillary dissection. Tumor location in the upper outer quadrant and postope rative trauma and/or infection were identifiable risk factors for lymphedem a. (C) 2001 American Cancer Society.