Comparative study of long-term morbidity in patients with breast cancer after sentinel lymph node biopsy and axillary sampling versus axillary dissection

Intraoperative examination of the sentinel lymph node biopsy may correctly detect axillary node metastases in more than 90% of the patients with breast cancer. The aims of this study were to assess the usefulness of axillary sampling in conjunction with sentinel node biopsy, and to compare the incidence of lymphoedema after treatment of the axilla. Patients and methods: Two-hundred and five women who underwent curative surgery for pT1-2, N0-1, M0 primary breast cancer, were retrospectively reviewed. According to the treatment of the axilla, four groups of age- and stage-matched patients were obtained: Group A (N=54 patients): sentinel node biopsy alone; Group B (N=48 patients): sentinel node biopsy and axillary sampling by using ultrasound scissors; Group C (N=53 patients): axillary dissection by using ultrasound scissors; Group D (N=50 patients): traditional axillary dissection. Patients were followed-up for at least 18 months. The diagnosis of lymphoedema was made when a difference of 2 cm or more was observed in the arm circumference between affected and non affected arms. Results: Final pathology showed axillary node metastases in 20, 17, 16, and 17 patients in Groups A, B, C, and D, respectively (p=NS, chi-squared test). In Group A and B patients frozen section examination of the sentinel node biopsy showed axillary node metastases in 16 of 20 (sensitivity=80%), and 16 of 17 cases (sensitivity=94.1%) patients, respectively (p=NS). At follow-up patients with lymphoedema were 2 (3.7%), 2 (4.2%), 3 (5.6%), and 8 (16%) in Groups A, B, C, and D, respectively (p=NS). Conclusions: Axillary sampling is a safe and low-morbidity procedure that in conjunction with sentinel node biopsy may reduce the number of false-negative results of sentinel node biopsy alone. Lymphoedema is a rare occurrence both in patients who underwent sentinel node biopsy alone, and in those who underwent axillary sampling. The use of US may reduce such late complication especially when axillary dissection is required.