Shoulder and arm morbidity in sentinel node-negative breast cancer patients : a systematic review
Faculty of Medicine and Health Sciences
Breast cancer research and treatment. - Dordrecht
, p. 21-31
University of Antwerp
The purpose of this study was to assess which shoulder and arm impairments are common in sentinel node-negative breast cancer patients and to describe the incidence and time course of these impairments. A systematic literature search was performed using different electronic databases until October 2013. Inclusion criteria were (1) research studies that included breast cancer patients surgically treated using the sentinel lymph node biopsy (SLNB) technique, (2) sentinel node-negative patients, and (3) studies that investigated morbidities of shoulder and/or arm. The exclusion criteria were (1) reviews or case studies, (2) patients who have had a SLNB followed by an axillary lymph node dissection (ALND), (3) results of ALND patients and SLNB patients were not described separately, and (4) no follow-up described. Thirty articles were included, representing 5,448 patients. Shoulder and arm impairments among sentinel node-negative patients are loss of mobility, loss of strength, pain, axillary web syndrome, and sensory disorders. Within the first month after SLNB, the morbidities with the highest incidence are decreased abduction (range 40.8100 %), forward flexion of the shoulder (range 37100 %), pain (range 3.456.6 %), and numbness (range 264 %). Morbidities with the highest incidence after 2 years are pain (range 5.651.1 %), numbness (range 5.151.1 %), loss of strength (range 057.7 %), decreased internal rotation (44.4 %), and decreased abduction (range 041.4 %). In conclusion, although the shoulder and arm impairments are less common after SLNB alone compared to ALND, they cannot be neglected. A considerable amount of patients still suffer from those impairments more than 2 years after surgery.