Comparison of Lymphedema in Patients With Axillary Lymph Node Dissections to Those With Sentinel Lymph Node Biopsy Followed by Immediate and Delayed ALND
Identifieur interne : 003C80 ( Main/Exploration ); précédent : 003C79; suivant : 003C81Comparison of Lymphedema in Patients With Axillary Lymph Node Dissections to Those With Sentinel Lymph Node Biopsy Followed by Immediate and Delayed ALND
Auteurs : Nafisa Kayam Kuwajerwala [États-Unis] ; Claire Feczko [États-Unis] ; Nayana Dekhne [États-Unis] ; Jane Pettinga [États-Unis] ; Victoria C. Lucia [États-Unis] ; Justin Riutta [États-Unis] ; Frank ViciniSource :
- American journal of clinical oncology [ 0277-3732 ] ; 2013.
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- Pascal (Inist)
- Wicri :
- topic : Homme.
English descriptors
- KwdEn :
Abstract
Purpose: The purpose of the study was to show that delayed axillary lymph node dissection (ALND) has higher rates of lymphedema compared with immediate ALND, using data from NSABP-B32 at Beaumont Hospital. Method: NSABP B-32 at Beaumont had 207 patients with follow-up data on 199 patients, randomizing clinically negative axilla to sentinel lymph node biopsy (SLNB)+ALND (GrA N=98), and SLNB+cytology±ALND (GrB N = 101). All patients had preoperative volumetric arm measurements and only node negatives had routine postoperative measurements assessing lymphedema for 36 months. We contacted node-positive patients for postoperative measurements for this study. Twenty-four and 15 cytology-positive patients had SLNB+ALND in GrA and GrB, respectively (SubGrA1 N=24; SubGrB1 N=15). Fourteen hematoxylin and eosin-positive patients had delayed ALND (SubGrB2a N = 14). Results: Lymphedema rate for node-positive SLNB+ALND was 10.3% [SubGrA1 (3/24)+SubGrB1 (1/15)=4/39] and node-negative SLNB+ ALND was 6.8% (SubGrA2=5/74). Lymphedema was 14.3% for delayed ALND in SubGrB2a (2 of 14) and 0% for 72 SLNBs in SubGrB2b. Our study comparing immediate and delayed ALND lymphedema was not statistically significant (10.3% vs. 14.3%, P= 0.65). Comparing node-negative ALND (SubGrA2= 5/74=6.8%) to node-positive ALND (A1+B1+B2a = 6/53 = 11.3%) was not statistically significant (P = 0.52). Comparing lymphedema for node-negative ALND (SubGrA2) to SLNB (SubGrB2b) only approached significance (6.8% vs. 0%, P=0.058). Conclusions: The rate of lymphedema was higher in delayed ALND but not statistically significant. Comparison, however, is difficult, given the limited sample size. We urge the other centers of NSABP-B32 to validate this, by contacting the node-positive patients for measurements. The lymphedema rate for SLNB alone was 0% and approached statistical significance when compared with node-negative ALND.
Affiliations:
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Le document en format XML
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<series><title level="j" type="main">American journal of clinical oncology</title>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Anatomic pathology</term>
<term>Axillary ganglion</term>
<term>Biopsy</term>
<term>Comparative study</term>
<term>Complication</term>
<term>Human</term>
<term>Lymphadenectomy</term>
<term>Lymphedema</term>
<term>Sentinel lymph node</term>
<term>Treatment</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr"><term>Etude comparative</term>
<term>Lymphoedème</term>
<term>Homme</term>
<term>Complication</term>
<term>Ganglion axillaire</term>
<term>Lymphadénectomie</term>
<term>Ganglion sentinelle</term>
<term>Biopsie</term>
<term>Anatomopathologie</term>
<term>Traitement</term>
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<keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</term>
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<front><div type="abstract" xml:lang="en">Purpose: The purpose of the study was to show that delayed axillary lymph node dissection (ALND) has higher rates of lymphedema compared with immediate ALND, using data from NSABP-B32 at Beaumont Hospital. Method: NSABP B-32 at Beaumont had 207 patients with follow-up data on 199 patients, randomizing clinically negative axilla to sentinel lymph node biopsy (SLNB)+ALND (GrA N=98), and SLNB+cytology±ALND (GrB N = 101). All patients had preoperative volumetric arm measurements and only node negatives had routine postoperative measurements assessing lymphedema for 36 months. We contacted node-positive patients for postoperative measurements for this study. Twenty-four and 15 cytology-positive patients had SLNB+ALND in GrA and GrB, respectively (SubGrA1 N=24; SubGrB1 N=15). Fourteen hematoxylin and eosin-positive patients had delayed ALND (SubGrB2a N = 14). Results: Lymphedema rate for node-positive SLNB+ALND was 10.3% [SubGrA1 (3/24)+SubGrB1 (1/15)=4/39] and node-negative SLNB+ ALND was 6.8% (SubGrA2=5/74). Lymphedema was 14.3% for delayed ALND in SubGrB2a (2 of 14) and 0% for 72 SLNBs in SubGrB2b. Our study comparing immediate and delayed ALND lymphedema was not statistically significant (10.3% vs. 14.3%, P= 0.65). Comparing node-negative ALND (SubGrA2= 5/74=6.8%) to node-positive ALND (A1+B1+B2a = 6/53 = 11.3%) was not statistically significant (P = 0.52). Comparing lymphedema for node-negative ALND (SubGrA2) to SLNB (SubGrB2b) only approached significance (6.8% vs. 0%, P=0.058). Conclusions: The rate of lymphedema was higher in delayed ALND but not statistically significant. Comparison, however, is difficult, given the limited sample size. We urge the other centers of NSABP-B32 to validate this, by contacting the node-positive patients for measurements. The lymphedema rate for SLNB alone was 0% and approached statistical significance when compared with node-negative ALND.</div>
</front>
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<tree><noCountry><name sortKey="Vicini, Frank" sort="Vicini, Frank" uniqKey="Vicini F" first="Frank" last="Vicini">Frank Vicini</name>
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<name sortKey="Lucia, Victoria C" sort="Lucia, Victoria C" uniqKey="Lucia V" first="Victoria C." last="Lucia">Victoria C. Lucia</name>
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