EVANSTON, IllinoisAlthough biopsy of sentinel lymph nodes is often
considered an almost risk-free procedure in the staging of breast cancer, a
retrospective chart review showed a surprising incidence of lymphedema
associated with this procedure. Carole H. Martz, RN, MS, and colleagues at
Evanston Northwestern Healthcare in Illinois reported a 3% risk of
lymphedema after sentinel lymph node biopsy (SNLB, n = 303), compared to a
17% risk after axillary dissection (n = 117).
"The risk of lymphedema following sentinel node biopsy is low but
real and should be treated as such. All patients need to have preoperative
education in preventive measures as well as baseline pre-op and post-op arm
measurements," Ms. Martz said.
Global recommendations for postoperative lymphedema prevention include
weight control, prompt reporting of infection in the limb or breast on the
operated side, avoidance of trauma to the arm (such as from blood pressure
cuffs, intravenous needles, or vaccinations), and use of a compression
garment for airline travel or vigorous exercise.
The retrospective chart review of SNLB patients in a clinical research
project at Evanston Northwestern Healthcare was prompted by several patients
who presented with lymphedema after having SNLB in conjunction with a
lumpectomy or mastectomy. Patients’ subjective reports included arm
heaviness, arm tightness, rings and clothing feeling tighter, or a change in
arm skin and tissue texture or feel.
The investigators pulled all charts on patients who had SLNB either alone
or followed by axillary lymph node dissection. "Our initial hypothesis
was that there would be no increased risk of lymphedema in the SNLB
patients," Ms. Martz said.
Lymphedema was defined as a 1-cm increase in arm circumference compared to preoperative measurements or
a 50 mL or greater volumetric measurement difference between arms.