Is lymphedema still a problem in the era of sentinel lymph node biopsy?

When we used to remove all teh lymph nodes under the arm, lymphedema was fairly common. Now we remove just 2-3 lymph nodes.

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DrKathleenTRuddy (Physician - Surgery - Breast (Verified) ) - 08 / 02 / 2011

1 vote(s) by member1136
Yes, it is; though the risk for lymphedema is markedly reduced with sentinel node biopsy compared to full axillary dissection.

In addition to degree of dissection, other risk factors for lymphedema have been identified: obesity, advanced age and extensive axillary involvement with tumor.

DrAttai (Physician - Surgery - Breast (Verified) ) - 08 / 04 / 2011

Unfortunately lymphedema does remain a problem, and as mentioned above, it can develop even after the removal of only one sentinel lymph node. However what has improved is awareness of the problem as well as the understanding that early detection and prompt evaluation and treatment by a certified lymphedema therapist can help keep the swelling under good control. Historically we have used tape measures or other relatively crude methods to assess swelling. A newer test (the L-Dex;http://www.impedimed.com/home.htm ), uses bioimpedence spectroscopy (differences in the rate of conduction of an electrical current) to detect differences in fluid content in a patient's arm before there is actually evidence of swelling, and studies are demonstrating that this very early detection leads to improved outcomes.
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Jan (Survivor (10 - 20 years)) - 08 / 04 / 2011

I agree with Dr. Kathleen TRuddy. There is still a risk because at least one lymph node has been removed, and that enough might trigger lymphedema, especially if the axial area is also radiated, further damaging the nodes.

member7038 (Current Patient) - 08 / 04 / 2011

Lymphedema after removal of one or more sentinel nodes can cause lymphedema in the affected ARM and/or in the breast and trunk. Any swelling or pain In the underarm area or breast should be promptly evaluated by a certified lymphedema therapist. Although this condition cannot be cured it can be treated. The key is to start therapy as soon as possible!

member1136 (Caregiver) - 11 / 20 / 2011

The widespread use of tangential breast irradiation for local control of recurrence has brought a new kind of lymphedema, different from the upper limb lymphedema commonly related to axillary surgery and radiation -- BREAST LYMPHEDEMA. The incidence of breast lymphedema, sometimes referred to as "delayed breast cellulitis" has been found to be on the order of 23% (clinical) and over 70% preclinical (Reference Rönkä 2004-5 and other investigators). So the reduction of number of nodes dissected for staging has reduced the risk of upper limb lymphedema from 24 to 7 percent, but the adjuvent radiotherapy to the breast increases risk of breast lymphedema a similar amount.
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