The incidence and time path of lymphedema in sentinel negative breast cancer patients : a systematic review
Faculty of Medicine and Health Sciences
Archives of physical medicine and rehabilitation. - Chicago, Ill., 1952, currens
, p. 1131-1139
University of Antwerp
Objective To systematically assess the incidence/prevalence and time path of lymphedema in sentinel node negative breast cancer patients. Data sources A systematic literature search was performed using four different electronic databases (Pubmed, Embase, Cochrane Clinical Trials, WoS) until November 2013. Study selection Inclusion criteria were: 1) research studies that included breast cancer patients who were surgically treated using the sentinel lymph node technique (SLNB), 2) sentinel node negative patients, 3) studies that investigated lymphedema as a primary or secondary outcome, 4) data extraction for incidence or time path of lymphedema was possible and 5) publication date starting from 1st January 2001. 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) studies not written in English . Data extraction after scoring the methodological quality of the selected studies, the crude data concerning the incidence of lymphedema were extracted. Data concerning the time points and the incidence of lymphedema were also extracted. Data synthesis 28 articles were included, representing 9,588 SLNB negative patients. The overall incidence of lymphedema in sentinel node negative breast cancer patients ranged from 0% to 63.4%. The studies that have assessed lymphedema at predefined time points, instead of a mean follow-up time, demonstrated an incidence range at ≤3, 6, 12, 18 or > 18 months post-surgery of 3.2-5%, 2-10%, 3-63.4%, 6.6-7% and 6.9-8.2% respectively. Conclusion In SLNB-patients there is still a problem of lymphedema, if so it mostly occurs 6 to 12 months after surgery. Due to different assessments and criteria there is a wide range in incidence. Clear definitions of lymphedema are absolutely necessary to tailor therapy.