Skip to main content
SpringerLink
Log in

Treatment-Related Upper Limb Morbidity 1 Year after Sentinel Lymph Node Biopsy or Axillary Lymph Node Dissection for Stage I or II Breast Cancer

  • Original Articles
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background: In a prospective study, upper limb morbidity and perceived disability/activities of daily life (ADLs) were assessed before and 1 year after sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND).

Methods: A total of 204 patients with stage I/II breast cancer (mean age, 55.6 years; SD, 11.6 years) entered the study, and 189 patients (93%) could be evaluated after 1 year. Fifty-eight patients (31%) underwent only SLNB, and 131 (69%) underwent ALND. Assessments performed before surgery (t0) and 1 year after surgery (t1), included pain, shoulder range of motion, muscle strength, upper arm/forearm circumference, and perceived shoulder disability/ADL.

Results: Considerable treatment-related upper limb morbidity was observed. Significant (P < .05) changes between t0 and t1 were found in all assessments except strength of elbow flexors. Patients in the ALND group showed significantly more changes in the range of motion in forward flexion, abduction, and abduction/external rotation; grip strength and strength of shoulder abductors; circumference of upper arm and forearm; and perceived shoulder disability in ADLs compared with the SLNB group. Multivariate linear regression analysis showed that ALND could predict a decrease of range of motion in forward flexion, abduction, strength of shoulder abductors, grip strength, and shoulder-related ADLs and an increase in the circumference of the upper arm. Radiation of the axilla (19 patients) predicts an additional decrease in shoulder range of motion.

Conclusions: One year after treatment of breast cancer, there is significantly less upper limb morbidity after SLNB compared with ALND. ALND is a predictor for upper limb morbidity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  1. Moffat FL, Senofsky GM, Davis K, et al. Axillary node dissection for early breast cancer: some is good, but all is better. J Surg Oncol 1992; 51: 8–13.

    PubMed  Google Scholar 

  2. Donegan WL. Prognostic factors: stage and receptor status in breast cancer. Cancer 1992; 70: 1755–64.

    PubMed  CAS  Google Scholar 

  3. Fisher B, Bauer M, Wickerham DL, et al. Relation of number of positive axillary nodes to the prognosis of patients with primary breast cancer. Cancer 1983; 52: 1551–7.

    CAS  PubMed  Google Scholar 

  4. Carter CL, Allen C, Henson DE. Relation of tumour size, lymph node status, and survival in 24,740 breast cancer cases. Cancer 1989; 63: 181–7.

    PubMed  CAS  Google Scholar 

  5. Recht A, Houlihan MJ. Axillary lymph nodes and breast cancer: a review. Cancer 1995; 76: 1491–512.

    PubMed  CAS  Google Scholar 

  6. Thomson AM, Air M, Jack WJL, Kerr GR, Rodger A, Chetty U. Arm morbidity after breast conservation and axillary therapy. Breast 1995; 4: 273–6.

    Google Scholar 

  7. Liljegren G, Holmberg L. Arm morbidity after sector resection and axillary dissection with or without postoperative radiotherapy in breast cancer stage I. Results from a randomised trial. Eur J Cancer 1997; 33: 193–9.

    PubMed  CAS  Google Scholar 

  8. Pezner RD, Patterson MP, Hill RL, et al. Arm lymphoedema in patients treated conservatively for breast cancer: relationship to patients age and axillary node dissection techniques. Int J Radiat Oncol Biol Phys 1986; 12: 2079–83.

    CAS  PubMed  Google Scholar 

  9. Ivens D, Hoe AL, Podd TJ, Hamilton CR, Taylor I, Royle GT. Assessment of morbidity from complete axillary dissection. Br J Cancer 1992; 66: 136–8.

    PubMed  CAS  Google Scholar 

  10. Warmuth MA, Bowen G, Pronitz LR, et al. Complications of axillary lymph node dissection for carcinoma of the breast. Cancer 1998; 83: 1362–8.

    PubMed  CAS  Google Scholar 

  11. Kuehn T, Klauss W, Darsow M, et al. Long-term morbidity following axillary dissection in breast cancer patients—clinical assessment, significance for life quality and the impact of demographic, oncologic and therapeutic factors. Breast Cancer Res Treat 2000; 64: 275–86.

    PubMed  CAS  Google Scholar 

  12. Rietman JS, Dijkstra PU, Hoekstra HJ, et al. Late morbidity after treatment of breast cancer in relation to daily activities and quality of life: a systematic review. Eur J Surg Oncol 2003; 29: 229–38.

    PubMed  CAS  Google Scholar 

  13. Tobin MB, Lacey HJ, Meyer L, Mortimer PS. The psychological morbidity of breast cancer-related arm swelling. Cancer 1993; 72: 3248–53.

    PubMed  CAS  Google Scholar 

  14. Hack TF, Cohen L, Katz J, Robson LS, Goss P. Physical and psychological morbidity after axillary lymph node dissection for breast cancer. J Clin Oncol 1999; 17: 143–9.

    PubMed  CAS  Google Scholar 

  15. Ververs JMMA, Roumen RMH, Vingerhoets AJJM, et al. Risk, severity and predictors of physical and psychological morbidity after axillary lymph node dissection for breast cancer. Eur J Cancer 2001; 37: 991–9.

    Article  CAS  PubMed  Google Scholar 

  16. Poole K, Fallowfield LJ. The psychological impact of post-operative arm morbidity following axillary surgery for breast cancer: a critical review. Breast 2002; 11: 81–7.

    PubMed  CAS  Google Scholar 

  17. Kwan W, Jackson J, Weir LM, Dingee C, McGregor G, Olivotto IA. Chronic arm morbidity after curative breast cancer treatment: prevalence and impact on quality of life. J Clin Oncol 2002; 20: 4242–8.

    PubMed  Google Scholar 

  18. Rietman JS, Dijkstra PU, Debreczeni R, Geertzen JHB, Robinson DPH, De Vries J. Impairments, disabilities and health related quality of life after treatment for breast cancer: a follow-up study 2.7 years after surgery. Disabil Rehabil 2004; 26: 78–84.

    PubMed  Google Scholar 

  19. Giuliano AE, Dale PS, Turner RR, et al. Improved axillary staging of breast cancer with sentinel lymphadenectomy. Ann Surg 1995; 222: 394–9.

    PubMed  CAS  Google Scholar 

  20. Statman RC, Jones RC, Cabot MC, et al. Sentinal lymphadenectomy. A technique to eliminate axillary dissection in node-negative breast cancer (abstract). Proc Am Soc Clin Oncol 1996; 15: 167A.

    Google Scholar 

  21. Veronesi U, Paganelli G, Galimberti V, et al. Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes. Lancet 1997; 349: 1864–7.

    Article  CAS  PubMed  Google Scholar 

  22. Sener SF, Winchester DJ, Martz CH, et al. Lymphedema after sentinel lymphadenectomy for breast carcinoma. Cancer 2001; 92: 748–52.

    Article  CAS  PubMed  Google Scholar 

  23. Veronesi U, Paganelli G, Viale G, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med 2003; 349: 546–53.

    Article  PubMed  Google Scholar 

  24. McMasters KM, Tuttle TM, Carlson DJ, et al. Sentinel lymph node biopsy for breast cancer: a suitable alternative to routine axillary dissection in multi-institutional practice when optimal technique is used. J Clin Oncol 2000; 18: 2560–6.

    PubMed  CAS  Google Scholar 

  25. Schrenk P, Rieger R, Shamiyeh A, Wayand W. Morbidity following sentinel lymph node biopsy versus axillary lymph node dissection for patients with breast carcinoma. Cancer 2000; 88: 608–14.

    PubMed  CAS  Google Scholar 

  26. Haid A, Köberle-Wührer R, Knauer M, et al. Morbidity of breast cancer patients following complete axillary dissection or sentinel node biopsy only: a comparative evaluation. Breast Cancer Res Treat 2002; 73: 31–6.

    PubMed  Google Scholar 

  27. Burak WE, Hollenbeck ST, Zervos EE, Hock KL, Kemp LC, Young DC. Sentinel lymph node biopsy results in less postoperative morbidity compared with axillary lymph node dissection for breast cancer. Am J Surg 2002; 183: 23–7.

    Article  PubMed  Google Scholar 

  28. Baron RH, Fey JV, Raboy S, et al. Eighteen sensations after breast cancer surgery: a comparison of sentinel lymph node biopsy and axillary lymph node dissection. Oncol Nurs Forum 2002; 29: 652–9.

    Google Scholar 

  29. Temple LKF, Baron R, Cody HS, et al. Sensory morbidity after sentinel lymph node biopsy and axillary dissection: a prospective study of 233 women. Ann Surg Oncol 2002; 9: 654–62.

    PubMed  Google Scholar 

  30. Swenson KK, Nissen MJ, Ceronsky C, Swenson L, Lee MW, Tuttle TM. Comparison of side effects between sentinel lymph node and axillary lymph node dissection for breast cancer. Ann Surg Oncol 2002; 9: 745–53.

    PubMed  Google Scholar 

  31. Haid A, Kuehn P, Konstantiniuk R, et al. Shoulder-arm morbidity following axillary dissection and sentinel node only biopsy for breast cancer. Eur J Surg Oncol 2002; 28: 705–10.

    PubMed  CAS  Google Scholar 

  32. Leidenius M, Leppänen, Krogerus L, von Smitten K. Motion restriction and axillary web syndrome after sentinel node biopsy and axillary clearance in breast cancer. Am J Surg 2003; 185: 127–30.

    PubMed  Google Scholar 

  33. Schijven MP, Vingerhoets AJJM, Rutten HJT, et al. Comparison of morbidity between axillary lymph node dissection and sentinel node biopsy. Eur J Surg Oncol 2003; 29: 341–50.

    PubMed  CAS  Google Scholar 

  34. Peintinger F, Reitsamer R, Stranzl H, Ralph G. Comparison of quality of life and arm complaints after axillary lymph node dissection vs sentinel lymph node biopsy in breast cancer patients. Br J Cancer 2003; 89: 648–52.

    PubMed  CAS  Google Scholar 

  35. Blanchard DK, Donohue JH, Reynolds C, Grant CS. Relapse and morbidity in patients undergoing sentinel lymph node biopsy alone or with axillary dissection for breast cancer. Arch Surg 2003; 138: 482–8.

    Article  PubMed  Google Scholar 

  36. Schrenk P, Hatzl-Griesenhofer M, Shamiyeh A, Waynad W. Follow-up of sentinel node negative breast cancer patients without axillary lymph node dissection. J Surg Oncol 2001; 77: 165–70.

    PubMed  CAS  Google Scholar 

  37. International Union Against Cancer. Breast tumours. In: Sobin LH, Wittekind Ch, eds. TNM: Classification of Malignant Tumours. 6th ed. New York: Wiley-Liss, 2002: 131–42.

  38. Rutgers EJ, Jansen L, Nieweg OE, de Vries J, Schraffordt Koops H, Kroon BB. Technique of sentinel node biopsy in breast cancer. Eur J Surg Oncol 1998; 24: 316–9.

    PubMed  CAS  Google Scholar 

  39. Hladiuk M, Huchcroft S, Temple W, Schnurr BE. Arm function after axillary dissection for breast cancer: a pilot study to provide parameter estimates. J Surg Oncol 1992; 50: 47–52.

    CAS  PubMed  Google Scholar 

  40. Gerber L, Lampert M, Wood C, et al. Comparison of pain, motion and edema after modified radical mastectomy vs. local excision with axillary dissection and radiation. Breast Cancer Res Treat 1992; 21: 139–45.

    PubMed  CAS  Google Scholar 

  41. Green S, Buchbinder R, Forbes A, Bellamy N. A standardised protocol for measurement of range of movement of the shoulder using the Plurimeter-V inclinometer and assessment of its intrarater and interrater reliability. Arthritis Care Res 1998; 11: 43–52.

    PubMed  CAS  Google Scholar 

  42. van der Ploeg RJO. Hand-Held Dynamometry (Thesis). Groningen, The Netherlands: University of Groningen, 1992.

  43. van der Ploeg RJO, Fidler V, Oosterhuis HJGH. Hand-held myometry: reference values. J Neurol Neurosurg Psychiatry 1991; 54: 244–7.

    PubMed  CAS  Google Scholar 

  44. Balogun JA, Powell R, Trullender B, Olson S, Balogun AO. Intra- and inter-tester reliability of the Nicholas® hand-held dynamometer during evaluation of upper extremity isometric muscle strength. Eur J Phys Med Rehabil 1998; 8: 48–53.

    Google Scholar 

  45. Swedborg I, Borg G, Sarnelid M. Somatic sensation and discomfort in the arm of post-mastectomy patients. Scand J Rehabil Med 1981; 13: 23–9.

    PubMed  CAS  Google Scholar 

  46. Mathiowetz V, Weber K, Volland G, Kashman N. Reliability and validity of grip and pinch strength evaluations. J Hand Surg 1984; 9: 222–6.

    CAS  Google Scholar 

  47. van der Heijden GJMG. Shoulder Disorder Treatment: Efficacy of Ultrasound Therapy and Electrotherapy (Thesis). Maastricht, The Netherlands: University of Maastricht, 1996.

  48. van der Heijden GJ, Leffers P, Bouter LM. Shoulder disability questionnaire design and responsiveness of a functional status measure. J Clin Epidemiol 2000; 53: 29–38.

    PubMed  CAS  Google Scholar 

  49. Kempen GI, Miedema I, Ormel J, Molenaar W. The assessment of disability with the Groningen Activity Restriction Scale. Conceptual framework and psychometric properties. Soc Sci Med 1996; 43: 1601–10.

    PubMed  CAS  Google Scholar 

  50. Suurmeijer TPBM, Doeglas DM, Moum T, et al. The Groningen Activity Restriction Scale for measuring disability: its utility in international comparisons. Am J Public Health 1994; 84: 170–3.

    Article  Google Scholar 

  51. Bentzen SM, Overgaard M, Thames HD. Fractionating sensitivity of a functional endpoint: impaired shoulder movement after post-mastectomy radiotherapy. Int J Radiat Oncol Biol Phys 1989; 17: 531–7.

    PubMed  CAS  Google Scholar 

  52. Sugden EM, Rezvani M, Harrison JM, Hughes LK. Shoulder movement after the treatment of early stage breast cancer. Clin Oncol (R Coll Radiol) 1998; 10: 173–81.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Rehabilitation Medicine, Martini Hospital, Groningen, The Netherlands

    J. S. Rietman MD

  2. Department of Rehabilitation Medicine, Groningen University Hospital, Groningen, The Netherlands

    J. S. Rietman MD, P. U. Dijkstra PT, MT, PhD, J. H. B. Geertzen MD, PhD & W. H. Eisma MD

  3. Northern Centre for Health Care Research, University Groningen, Groningen, The Netherlands

    J. S. Rietman MD, P. U. Dijkstra PT, MT, PhD, J. H. B. Geertzen MD, PhD & J. W. Groothoff MSc, PhD

  4. Department of Surgery, Martini Hospital, Groningen, The Netherlands

    P. Baas MD, PhD

  5. Department of Surgical Oncology, Groningen University Hospital, Groningen, The Netherlands

    J. de Vries MD, PhD & H. J. Hoekstra MD, PhD

  6. Department of Radiation Oncology, Groningen University Hospital, Groningen, The Netherlands

    W. V. Dolsma MD, PhD

  7. Department of Rehabilitation Medicine, Martini Hospital Groningen, PO Box 30033, NL-9700 RM, Groningen, The Netherlands

    J. S. Rietman MD

Authors
  1. J. S. Rietman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. U. Dijkstra PT, MT, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. H. B. Geertzen MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Baas MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. de Vries MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. W. V. Dolsma MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. W. Groothoff MSc, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. W. H. Eisma MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. H. J. Hoekstra MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. S. Rietman MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rietman, J.S., Dijkstra, P.U., Geertzen, J.H.B. et al. Treatment-Related Upper Limb Morbidity 1 Year after Sentinel Lymph Node Biopsy or Axillary Lymph Node Dissection for Stage I or II Breast Cancer. Ann Surg Oncol 11, 1018–1024 (2004). https://doi.org/10.1245/ASO.2004.03.512

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1245/ASO.2004.03.512

Key Words:

Search

Navigation