Surgical complications associated with sentinel lymph node biopsy: Results from a prospective international cooperative group trial

Lee Gravatt Wilke, Linda M. McCall, Katherine E. Posther, Pat W. Whitworth, Douglas S. Reintgen, A. Marilyn Leitch, Sheryl G A Gabram, Anthony Lucci, Charles E. Cox, Kelly K. Hunt, James E. Herndon, Armando E. Giuliano

Research output: Contribution to journalArticle

383 Citations (Scopus)

Abstract

Background: American College of Surgeons Oncology Group Z0010 is a prospective multicenter trial designed to evaluate the prognostic significance of micrometastases in the sentinel lymph nodes and bone marrow aspirates of women with early-stage breast cancer. Surgical complications associated with the sentinel lymph node biopsy surgical procedure are reported. Methods: Eligible patients included women with clinical T1/2N0M0 breast cancer. Surgical outcomes were available at 30 days and 6 months after surgery for 5327 patients. Patients who had a failed sentinel node mapping (n = 71, 1.4%) or a completion lymph node dissection (n = 814, 15%) were excluded. Univariate and multivariate analyses were performed to identify predictors for the measured surgical complications. Results: In patients who received isosulfan blue dye alone (n = 783) or a combination of blue dye and radiocolloid (n = 4192), anaphylaxis was reported in .1% of subjects (5 of 4975). Other complications included axillary wound infection in 1.0%, axillary seroma in 7.1%, and axillary hematoma in 1.4% of subjects. Only increasing age and an increasing number of sentinel lymph nodes removed were significantly associated with an increasing incidence of axillary seroma. At 6 months, 8.6% of patients reported axillary paresthesias, 3.8% had a decreased upper extremity range of motion, and 6.9% demonstrated proximal upper extremity lymphedema (change from baseline arm circumference of >2 cm). Significant predictors for surgical complications at 6 months were a decreasing age for axillary paresthesias and increasing body mass index and increasing age for upper extremity lymphedema. Conclusions: This study provides a prospective assessment of the sentinel lymph node biopsy procedure, as performed by a wide range of surgeons, demonstrating a low complication rate.

Original languageEnglish (US)
Pages (from-to)491-500
Number of pages10
JournalAnnals of Surgical Oncology
Volume13
Issue number4
DOIs
StatePublished - Apr 2006

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Sentinel Lymph Node Biopsy
Upper Extremity
Seroma
Lymphedema
Paresthesia
Coloring Agents
Breast Neoplasms
Neoplasm Micrometastasis
Anaphylaxis
Wound Infection
Articular Range of Motion
Lymph Node Excision
Hematoma
Multicenter Studies
Body Mass Index
Arm
Multivariate Analysis
Bone Marrow
Incidence

Keywords

  • Biopsy
  • Breast cancer
  • Complications
  • Sentinel lymph node

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Surgical complications associated with sentinel lymph node biopsy : Results from a prospective international cooperative group trial. / Wilke, Lee Gravatt; McCall, Linda M.; Posther, Katherine E.; Whitworth, Pat W.; Reintgen, Douglas S.; Leitch, A. Marilyn; Gabram, Sheryl G A; Lucci, Anthony; Cox, Charles E.; Hunt, Kelly K.; Herndon, James E.; Giuliano, Armando E.

In: Annals of Surgical Oncology, Vol. 13, No. 4, 04.2006, p. 491-500.

Research output: Contribution to journalArticle

Wilke, LG, McCall, LM, Posther, KE, Whitworth, PW, Reintgen, DS, Leitch, AM, Gabram, SGA, Lucci, A, Cox, CE, Hunt, KK, Herndon, JE & Giuliano, AE 2006, 'Surgical complications associated with sentinel lymph node biopsy: Results from a prospective international cooperative group trial', Annals of Surgical Oncology, vol. 13, no. 4, pp. 491-500. https://doi.org/10.1245/ASO.2006.05.013
Wilke, Lee Gravatt ; McCall, Linda M. ; Posther, Katherine E. ; Whitworth, Pat W. ; Reintgen, Douglas S. ; Leitch, A. Marilyn ; Gabram, Sheryl G A ; Lucci, Anthony ; Cox, Charles E. ; Hunt, Kelly K. ; Herndon, James E. ; Giuliano, Armando E. / Surgical complications associated with sentinel lymph node biopsy : Results from a prospective international cooperative group trial. In: Annals of Surgical Oncology. 2006 ; Vol. 13, No. 4. pp. 491-500.
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abstract = "Background: American College of Surgeons Oncology Group Z0010 is a prospective multicenter trial designed to evaluate the prognostic significance of micrometastases in the sentinel lymph nodes and bone marrow aspirates of women with early-stage breast cancer. Surgical complications associated with the sentinel lymph node biopsy surgical procedure are reported. Methods: Eligible patients included women with clinical T1/2N0M0 breast cancer. Surgical outcomes were available at 30 days and 6 months after surgery for 5327 patients. Patients who had a failed sentinel node mapping (n = 71, 1.4{\%}) or a completion lymph node dissection (n = 814, 15{\%}) were excluded. Univariate and multivariate analyses were performed to identify predictors for the measured surgical complications. Results: In patients who received isosulfan blue dye alone (n = 783) or a combination of blue dye and radiocolloid (n = 4192), anaphylaxis was reported in .1{\%} of subjects (5 of 4975). Other complications included axillary wound infection in 1.0{\%}, axillary seroma in 7.1{\%}, and axillary hematoma in 1.4{\%} of subjects. Only increasing age and an increasing number of sentinel lymph nodes removed were significantly associated with an increasing incidence of axillary seroma. At 6 months, 8.6{\%} of patients reported axillary paresthesias, 3.8{\%} had a decreased upper extremity range of motion, and 6.9{\%} demonstrated proximal upper extremity lymphedema (change from baseline arm circumference of >2 cm). Significant predictors for surgical complications at 6 months were a decreasing age for axillary paresthesias and increasing body mass index and increasing age for upper extremity lymphedema. Conclusions: This study provides a prospective assessment of the sentinel lymph node biopsy procedure, as performed by a wide range of surgeons, demonstrating a low complication rate.",
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AU - Whitworth, Pat W.

AU - Reintgen, Douglas S.

AU - Leitch, A. Marilyn

AU - Gabram, Sheryl G A

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