Sentinel node biopsy (SNB) is conc...

Sentinel node biopsy (SNB) is conception to provide accurate lymphatic staging of the axilla in breast cancer surgery with les morbidity than the traditional axillary clearance (AC) deed Nevertheless, stasis, lymphovenous damage, hypercoagulability, and tissue injury from either proceeding could cause axillary web syndrome Leidenius and colleagues compared the rates of shoulder restriction and axillary web syndrome in women undergoing SNB or AC in a Finnish teaching hospital.

The 85 studious mood participants were assessed by a physical therapist before surgery to document their range of shoulder flexion and abduction. Any preoperative symptoms of axillary web syndrome as it is as palpable or visible tissue cords, pain, or limitation of range of motion, were documented. More than individual half of the women (49 patients) underwent SNB barely AC was performed in 36 patients because metastases were identified in frozen sections of the sentinel node, multifocal carcinoma was exposeed or sentinel nodes could not be identified. Axillary metastases were identified in five women in the SNB form into groups (10 percent) and 30 women in the AC cluster (83 percent). The median number of axillary nodes remov was three (range, single to nine) in the SNB assign places to and 16 (range, nine to 29) in the AC clump A physical therapist reassessed all patients sum of two units weeks and three months after surgery and a surgeon examined the women pair weeks after surgery to document signs of axillary web syndrome

Shoulder function was identical in the couple groups before surgery. Two weeks later, 24 women in the SNB clump (45 percent) and 31 of the women in the AC cluster (86 percent) had restricted shoulder abduction and flexion. Among women with normal measurements of function, an additional 15 patients in the SNB clump and five in the AC arrange reported subjective symptoms of shoulder restriction. These patients attributed their symptoms to axillary web syndrome or pain in the injury axilla, or pectoral muscles. A surgeon diagnosed axillary web syndrome in 10 women in the SNB clump (20 percent) and 26 women in the AC assemblage (72 percent). Postoperative shoulder restriction was not related to preoperative shoulder function or the port of axillary metastases. Restricted shoulder function and axillary web syndrome were les frequent in obese patients. Three month after surgery almost all patients had satiated range of shoulder abduction and flexion.

The authors judge that women who underwent SNB experienced les restriction of shoulder function than women who underwent AC. Nevertheless, 75 percent of women who had SNB had significant symptoms couple weeks after surgery. All patients who underwent AC had objective or subjective functional shoulder restriction sum of two units weeks after surgery. Three month after surgery symptoms had resolv in almost all patients.

Leidenius M et al. Motion restriction and axillary web syndrome after sentinel node biopsy and axillary clearance in breast cancer. Am J Surg February 2003;185:127-30

EDITOR'S NOTE: With with equal reason much optimistic news about improved survival with early detection of breast cancer, many women approach breast-conserving surgery with high expectations. They anticipate a brief hospital stay and a rapid get back to normal activities. For many women postoperative symptoms reach [i]or[/i] attain any place [i]or[/i] point as a nasty and unexpect agitation This study shows that on the same level with minimal axillary surgery, 75 percent of women had symptoms at the two-week follow-up Family physicians should encourage an optimistic watch but must prepare patients for any shoulder symptoms and arrange for suitable therapy.--A.D.W.

COPYRIGHT 2003 American Academy of Family Physicians

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