Sentinel-lymph-node-based management or routine axillary clearance? Five-year outcomes of the RACS Sentinel Node Biopsy Versus Axillary Clearance (SNAC) 1 Trial: Assessment and Incidence of True Lymphedema. Lymphedema symptoms and limb measurement changes in breast cancer survivors treated with neoadjuvant chemotherapy and axillary dissection: results of American College of Surgeons Oncology Group (ACOSOG) Z1071 (Alliance) substudy. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Objective assessment of postoperative morbidity after breast cancer treatments with wearable activity monitors: The “BRACELET” Study. 2014 9:e96748.Ĭhe Bakri NA, Kwasnicki RM, Dhillon K, et al. Treatment related impairments in arm and shoulder in patients with breast cancer: a systematic review. Axillary ultrasonography (US) is the most commonly used imaging modality for nodal evaluation in patients with breast cancer. Hidding JT, Beurskens CH, van der Wees PJ, et al. The findings support the continued drive to de-escalate axillary surgery.Ĭopyright © 2022 The Author(s). ALND patients experienced greater rates of lymphedema, pain, reduced strength, and range of motion compared with SLNB. Prevalence of lymphedema after ALND was higher than previously estimated. Type of axillary surgery, greater body mass index, and radiotherapy were some of the predictors for UL morbidities. Pooled estimates for prevalence of reduced strength and range of motion after SLNB and ALND were 15.2% versus 30.9% and 17.1% versus 29.8%, respectively. The difference in lymphedema and pain prevalence between SLNB and ALND was 13.7% (95% confidence interval: 10.5-16.8, P <0.005) and 24.2% (95% confidence interval: 12.1-36.3, P <0.005), respectively. All studies reported a higher rate of lymphedema and pain after ALND compared with SLNB. The prevalence of UL morbidity comparing SLNB and ALND at <12 months, 12 to 24 months, and beyond 24 months were analyzed. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included studies were randomized-controlled and observational studies focusing on UL morbidities, in breast surgery patients. Understanding the impact of axillary surgery and disparities in operative procedures on postoperative arm morbidity would better direct resources to the point of need and cement the need for de-escalation strategies.Įmbase, MEDLINE, CINAHL, and PsychINFO were searched from 1990 until March 2020. All rights reserved.To evaluate the impact of axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SLNB) on upper limb (UL) morbidity in breast cancer patients.Īxillary de-escalation is motivated by a desire to reduce harm of ALND. SLNB at in-breast relapse is feasible and safe with successful localisation related to the extent of previous axillary surgery.Ĭopyright © 2011 Elsevier Ltd. In these highly selected patients no axillary recurrences were noted in those who had a negative SLN at re-operation after 26-46 months follow up. In patients who have previously had limited axillary surgery (<9 nodes removed), the rate of successful SLN localisation was 83% (165/199), range of 68-100% and 142/165 (86%, range 80-100%) were node negative. There was an overall successful sentinel lymph node (SLN) localisation at re-operation of 69% (227/327), range of 51-100%. Six reports with 327 cases were identified of which 61% (199/327) had previous SLNB or ALND with <9 nodes removed. We reviewed published reports of SLNB at local relapse in women who had previously undergone axillary surgery either as lymph node biopsy, SLNB, axillary sampling (AS) or axillary lymph node dissection (ALND). ![]() This review examines the role of SLNB in the re-operative setting with the objective of developing an axillary management algorithm for use at in-breast local relapse, and restricting ALND to node-positive recurrent cancers. Axillary lymph node involvement is one important prognostic factor in breast cancer, but the way to access this information has been modified over the years. At primary diagnosis the use of sentinel lymph node biopsy (SLNB) has restricted ALND for proven nodal disease, however the management of the axilla at local (in-breast) relapse is less clearly defined with many undergoing routine ALND. The utility of axillary lymph node dissection (ALND) in the management of breast cancer is currently under close scrutiny.
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