J Breast Cancer.  2021 Feb;24(1):63-74. 10.4048/jbc.2021.24.e9.

Association between Number of Retrieved Sentinel Lymph Nodes and Breast Cancer-related Lymphedema

Affiliations
  • 1Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
  • 2Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
  • 3Department of Surgery, Ewha Womans University Medical Center, Seoul, Korea
  • 4Pusan National University Hospital, Busan Cancer Center, Busan, Korea
  • 5Cancer Research Institute, Seoul National University, Seoul, Korea
  • 6Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea

Abstract

Purpose
Sentinel lymph node biopsy (SLNB) has become a standard axillary staging surgery for early breast cancer, and the proportion of patients requiring axillary lymph node dissection (ALND) is decreasing. We aimed to evaluate the association between the number of sentinel lymph nodes (SLNs) retrieved and the risk of lymphedema of the ipsilateral arm.
Methods
Prospectively collected medical records of 910 patients were reviewed. Lymphedema was defined as a difference in circumference > 2 cm compared to the contralateral arm and/or having clinical records of lymphedema treatment in the rehabilitation clinic.
Results
Together with an objective and subjective assessment of lymphedema, 36 patients (6.1%) had lymphedema in the SLNB group and 85 patients (27.0%) had lymphedema in the ALND group (p < 0.001). In a multivariate analysis of the whole cohort, risk factors significantly associated risk with the development of lymphedema were body mass index, mastectomy (vs.breast-conserving surgery), ALND, and radiation therapy. In logistic regression models in the SLNB group only, there was no correlation between the number of retrieved SLNs and the incidence of lymphedema. In addition, in the Pearson correlation analysis, no correlation was observed between the number of retrieved SLNs and the difference in circumference between the ipsilateral and contralateral upper extremities (correlation coefficients = 0.067, p = 0.111).
Conclusion
The risk of lymphedema in breast cancer surgery and adjuvant treatments is multifactorial. The number of retrieved lymph nodes during sentinel biopsy was not associated with the incidence of lymphedema.

Keyword

Breast neoplasms; Lymphedema; Sentinel lymph node biopsy
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