Diminishing morbidity with the increased use of sentinel node biopsy in breast carcinoma

Abstract

Background: Sentinel lymph node biopsy has largely replaced axillary node dissection in the staging of women with clinically negative axillas. The aim of this study was to compare the morbidity of sentinel node biopsy only, sentinel node biopsy followed by axillary dissection, and axillary node dissection only.

Methods: Retrospective review of a prospectively maintained database of patients who underwent sentinel lymph node biopsy, axillary lymph node dissection, or both between June 1996 and August 2008 was performed. The incidence of postoperative complications, including arm cellulitis, diminished shoulder range of motion, axillary hematoma, intercostal brachial nerve injury, pulmonary embolus or deep-vein thrombosis, lymphocele requiring aspiration, wound dehiscence, and wound infection, was compared among the 3 groups using Fisher's exact test.

Results: Of the 6,847 axillary operations performed, 2,745 (40%) were sentinel node biopsy only, 1,825 (27%) were sentinel lymph node biopsy followed by completion axillary dissection, and 2,277 (33%) were axillary dissection only. The mean node retrieval was 2 for sentinel node biopsy, 13 for sentinel node biopsy and completion axillary dissection, and 14 for axillary dissection. The mean age was 58 years. The overall complication rate was higher during the first half of the study period than during the second half (9.9% vs 3.9%, P < .0001). Axillary dissection had the highest overall complication rate (11.1%), followed by sentinel node biopsy and completion axillary dissection (7.3%), followed by sentinel node biopsy alone (2.6%) (P < .0001). Significantly less shoulder range of motion limitation, axillary hematoma, and lymphocele requiring aspiration were seen after sentinel node biopsy alone than after sentinel node biopsy plus completion axillary dissection or axillary dissection alone (P < .0001). Wound infection was also significantly less common after sentinel node biopsy than after axillary dissection (P = .02). No difference was seen in incidence of postoperative pulmonary embolus or deep-vein thrombosis, arm cellulitis, intercostal brachial nerve injury, or wound dehiscence.

Conclusions: Sentinel lymph node biopsy is less morbid than sentinel node biopsy followed by completion axillary dissection and axillary node dissection alone. The morbidity of axillary surgery has decreased over time.