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Comparison of Lymphedema in Patients With Axillary Lymph Node Dissections to Those With Sentinel Lymph Node Biopsy Followed by Immediate and Delayed ALND

Kuwajerwala, Nafisa Kayam MD, FACS*; Feczko, Claire BS, CCRP; Dekhne, Nayana MD, FACS*; Pettinga, Jane MD*; Lucia, Victoria C. PhD; Riutta, Justin MD§; Vicini, Frank MD, FACR

American Journal of Clinical Oncology: February 2013 - Volume 36 - Issue 1 - p 20–23
doi: 10.1097/COC.0b013e31823a4956
Original Articles: Breast

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.

*Departments of Surgery, William Beaumont Hospital, Troy and Royal Oak

Cancer Clinical Trials

§Physical Medicine and Rehabilitation

Research Institute, William Beaumont Hospital

Department of Radiation Oncology, Royal Oak, MI

The authors declare no conflicts of interest.

Reprints: Frank Vicini, MD, FACR, Oncology, William Beaumont Hospital, Royal Oak, MI. E-mail:

© 2013 by Lippincott Williams & Wilkins, Inc