LYMPHEDEMA FOLLOWING BREAST CANCER TREATMENT, INCLUDING SENTINEL LYMPH NODE BIOPSY

Abstract

To compare the occurrence, signs, andsymptoms of lymphedema (LE) the arms ofwomen after axillary lymph node dissection(ALND), sentinel lymph node biopsy (SLNB),combined SLNB and ALND (Both), or neitheras part of breast cancer diagnosis and treatment,a concurrent descriptive-comparativecross-sectional four-group design withretrospective chart review was carried out. Ina convenience sample of 102 women treatedfor breast cancer and receiving follow-up careat a midwestern United States cancer center,sequential circumferential measurements atfive selected anatomical sites along both armsand hands were used to determine thepresence of LE (? 2 cm differences betweensites). Participants self-reported LE-relatedsigns and symptoms by interview andcompletion of the Lymphedema and BreastCancer Questionnaire (LBCQ). Retrospectivechart review was carried out to verify lymphnode-related diagnostic and treatmentprocedures. Based on node group, LE occurredas follows: 43.3% (29 of 67) of women whounderwent ALND alone; 22.2% (2 of 9) ofthose who underwent SLNB alone; 25.0%(3 of 12) of those with combined SLNB andALND; and 22.2% (2 of 9) with neither SLNBnor ALND. LE-related symptoms werereported by women who underwent ALNDalone, SLND alone, combined SLNB andALND, and neither. Among the node groups,three symptoms were more common: largerarm size, firmness/tightness in past year, andnumbness in past year. We conclude thatcircumferential measurements of the upperarm and forearm may be critical fordistinguishing LE from no LE. Overall, theproportion of women who experienced LErelatedsigns and symptoms was higher amongwomen who underwent ALND versus SLNB.However, numbness and tenderness frequentlywere reported by those undergoing ALND,SLNB or both; and by women without LE.ft is possible that some frequently occurringsymptoms, such as numbness and tenderness,may be related to breast cancer surgery andnot LE. Findings from this study can assisthealth professionals in educating women withbreast cancer about LE risk factors, as well asearly detection and management of LE byusing the LBCQ and sequential circumferentialarm measurements to evaluate limb changessubjectively and objectively concurrent witheach breast cancer survivor's follow-up care.