Prevalence of Lymphedema in Women With Breast Cancer 5 Years After Sentinel Lymph Node Biopsy or Axillary Dissection: Patient Perceptions and Precautionary Behaviors
Prevalence of Lymphedema in Women With Breast Cancer 5 Years After Sentinel Lymph Node Biopsy or Axillary Dissection: Patient Perceptions and Precautionary Behaviors
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DOI：
10.1200/jco.2008.16.3766
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发表时间：
2008-11-10
影响因子：
45.3
通讯作者：
Van Zee, Kimberly J.
中科院分区：
文献类型：
--
作者：
McLaughlin, Sarah A.;Wright, Mary J.;Van Zee, Kimberly J.
目的采用前哨淋巴结(SLN)活检对腋窝进行分期，以降低乳腺癌女性患者淋巴水肿的风险。在1999年6月1日至2003年5月30日期间，对936名接受SLN活检术(SLNB)或SLNB加腋窝淋巴结清扫术(SLNB/ALND)的妇女进行了中位数5年的评估。通过访谈和使用验证工具评估患者感知的淋巴水肿和逃避行为，并与手臂测量进行比较。结果目前报告的手臂肿胀在接受SLNB治疗的患者中为3%，而接受SLNB/ALND治疗的患者为27%(P<；.0001)，而测量到的淋巴水肿分别为5%和16%。在报告手臂肿胀的患者中，只有41%的患者测量到了淋巴水肿，而在报告没有手臂肿胀的患者中，只有5%的患者测量到了淋巴水肿。报告的与手臂肿胀相关的危险因素包括较大的体重(P<；.0001)、较高的体重指数(P<；.0001)、感染(P<；.0001)以及手术后同侧手臂的损伤(P=.007)。如果患者测量或感觉到淋巴水肿，他们会遵循更多的预防措施。结论体重、感染和损伤是感觉到淋巴水肿的重要危险因素。测量到的淋巴水肿和患者感觉到的淋巴水肿之间存在显著的不一致。与SLNB/ALND相比，单用SLNB术后5年患者感觉到的手臂肿胀的发生率显著降低，而且感觉到的女性比测量到的要少。
PurposeSentinel lymph node (SLN) biopsy was adopted for the staging of the axilla with the assumption that it would reduce the risk of lymphedema in women with breast cancer. This study was undertaken to examine patient perceptions of lymphedema and use of precautionary behaviors several years after axillary surgery.Patients and MethodsNine hundred thirty-six women who underwent SLN biopsy (SLNB) alone or SLNB followed by axillary lymph node dissection (SLNB/ALND) between June 1, 1999, and May 30, 2003, were evaluated at a median of 5 years after surgery. Patient-perceived lymphedema and avoidant behaviors were assessed through interview and administered a validated instrument, and compared with arm measurements.ResultsCurrent arm swelling was reported in 3% of patients who received SLNB alone versus 27% of patients who received SLNB/ALND (P < .0001), as compared with 5% and 16%, respectively, with measured lymphedema. Only 41% of patients reporting arm swelling had measured lymphedema, and 5% of patients reporting no arm swelling had measured lymphedema. Risk factors associated with reported arm swelling were greater body weight (P < .0001), higher body mass index (P < .0001), infection (P < .0001), and injury (P = .007) in the ipsilateral arm since surgery. Patients followed more precautions if they had measured or perceived lymphedema.ConclusionBody weight, infection, and injury are significant risk factors for perceiving lymphedema. There is significant discordance between the presence of measured and patient-perceived lymphedema. When compared to SLNB/ALND, SLNB-alone results in a significantly lower rate of patient-perceived arm swelling 5 years postoperatively, and is perceived by fewer women than are measured to have it.