SLN +ALN=Sentinel Lymph Node+Axillary Lymph Node 1 Summation of patients with mild and severe symptoms.

Table 1. A summary of incidence of lymphedema from the published studies.

4.6 749 <3cm,

3 891 <2cm, L, with

determine body mass index (BMI). A BMI greater than or equal to 25 warrants a consultation with a dietician and a BMI greater or equal to 30 warrants a consultation with a dietician and a weight reduction (Ridner et al., 2011; Helyer et al., 2010; Centers for Disease Control, 2011).

Patients that have been diagnosed with breast cancer should have baseline pre and posttreatment arm measurements taken on both arms and should be given this information to share with other healthcare providers. Lymphedema warrants active surveillance posttreatment for such symptoms as swelling, heaviness or tightness in the affected arm(s), and at‐risk chest and truncal areas. If there appears to be an increase of 1 cm in any of the circumference measurements when compared to the contralateral limb, the patient should schedule a follow‐up visit in 1 month. A 2 cm change in any of the circumferential measurements or a 5% volume change in an at‐risk limb warrant immediate referral for further evaluation by a professional trained in lymphedema assessment and management. Subjective symptom reports should be taken seriously and may include perceived swelling, tightness, tingling, and heaviness (Farrow, 2010c).

Surgical techniques of managing breast cancer and long-term morbidity include radical mastectomy, modified radical mastectomy, and lumpectomy. Surgical approaches to axillary treatment include sentinel lymph node dissection (SLND) and axillary lymph node dissection (ALND). The number of lymph nodes that defines ALND is 10, and the standard ALND involved at least dissection of levels I-II axillary lymph nodes, based on the arbitrarily set anatomic Berg principles (Berg, 1955). Identification of a sentinel lymph node for SLND is typically done by either an injection of the isosulfan blue dye, the technetium (99mTc)-sulphur colloid, or both. All blue-stained nodes and/or nodes with radioactive counts, as measured with the gamma probe, are defined as sentinel lymph nodes. Typically, the number of nodes sample as a result of a SLND is small, with a median number of 2 nodes (Wernicke, 2010).

A number of efforts have been employed to minimize the risk of lymphedema (Figure 2B), as it is associated with the dissection of a large number of axillary lymph nodes. Various studies have determined the incidence of lymphedema depending on the type of lymph node dissection, ALND versus SLND. Table I summarizes the incidence of lymphedema based on the type of axillary lymph node surgery – SLND or ALND – from a number of published studies for both node negative and node positive patients. The Milan trial, the Sentinella/GIVOM trial, The ALMANAC-UK trial, and the NSABP B-32 trial all showcase node negative patients in the varying prospective randomized trials (Veronesi et al., 2003, 1997; Land et al., 2010; Mclaughlin et al., 2008; Ashikaga et al., 2008; Mansel et al., 2006). In the Milan Trial, at the median follow up of 3 years lymphedema, as assessed by a medical professional, was detectable in 7/100 (7%) of patients in the SLND group in contrast with 75/100 (75%) of cases of lymphedema in the ALND group (Veronesi et al., 2003, 1997). In the Sentinella/GIVOM trial, it was found that the odds ratio of sentinel lymph node to axillary lymph node was 0.52 at their median follow up of 4.6 years (Land et al., 2010). In the ALMANAC-UK trial, with a short median follow up of 1 year lymphedema was assessed by a patient and was reported in 20/412 (4.9%) of patients in the SLND group in contrast with 53/403 (13%) of cases of lymphedema in the ALND group (Mclaughlin et al., 2008).

determine body mass index (BMI). A BMI greater than or equal to 25 warrants a consultation with a dietician and a BMI greater or equal to 30 warrants a consultation with a dietician and a weight reduction (Ridner et al., 2011; Helyer et al., 2010; Centers for

Patients that have been diagnosed with breast cancer should have baseline pre and posttreatment arm measurements taken on both arms and should be given this information to share with other healthcare providers. Lymphedema warrants active surveillance posttreatment for such symptoms as swelling, heaviness or tightness in the affected arm(s), and at‐risk chest and truncal areas. If there appears to be an increase of 1 cm in any of the circumference measurements when compared to the contralateral limb, the patient should schedule a follow‐up visit in 1 month. A 2 cm change in any of the circumferential measurements or a 5% volume change in an at‐risk limb warrant immediate referral for further evaluation by a professional trained in lymphedema assessment and management. Subjective symptom reports should be taken seriously and may include perceived swelling,

Surgical techniques of managing breast cancer and long-term morbidity include radical mastectomy, modified radical mastectomy, and lumpectomy. Surgical approaches to axillary treatment include sentinel lymph node dissection (SLND) and axillary lymph node dissection (ALND). The number of lymph nodes that defines ALND is 10, and the standard ALND involved at least dissection of levels I-II axillary lymph nodes, based on the arbitrarily set anatomic Berg principles (Berg, 1955). Identification of a sentinel lymph node for SLND is typically done by either an injection of the isosulfan blue dye, the technetium (99mTc)-sulphur colloid, or both. All blue-stained nodes and/or nodes with radioactive counts, as measured with the gamma probe, are defined as sentinel lymph nodes. Typically, the number of nodes sample as a result of a SLND is small, with a median number of 2

A number of efforts have been employed to minimize the risk of lymphedema (Figure 2B), as it is associated with the dissection of a large number of axillary lymph nodes. Various studies have determined the incidence of lymphedema depending on the type of lymph node dissection, ALND versus SLND. Table I summarizes the incidence of lymphedema based on the type of axillary lymph node surgery – SLND or ALND – from a number of published studies for both node negative and node positive patients. The Milan trial, the Sentinella/GIVOM trial, The ALMANAC-UK trial, and the NSABP B-32 trial all showcase node negative patients in the varying prospective randomized trials (Veronesi et al., 2003, 1997; Land et al., 2010; Mclaughlin et al., 2008; Ashikaga et al., 2008; Mansel et al., 2006). In the Milan Trial, at the median follow up of 3 years lymphedema, as assessed by a medical professional, was detectable in 7/100 (7%) of patients in the SLND group in contrast with 75/100 (75%) of cases of lymphedema in the ALND group (Veronesi et al., 2003, 1997). In the Sentinella/GIVOM trial, it was found that the odds ratio of sentinel lymph node to axillary lymph node was 0.52 at their median follow up of 4.6 years (Land et al., 2010). In the ALMANAC-UK trial, with a short median follow up of 1 year lymphedema was assessed by a patient and was reported in 20/412 (4.9%) of patients in the SLND group in contrast with 53/403 (13%) of cases of lymphedema in the ALND

Disease Control, 2011).

nodes (Wernicke, 2010).

group (Mclaughlin et al., 2008).

tightness, tingling, and heaviness (Farrow, 2010c).


L=lumpectomy

MRM=modified radical mastectomy

RT=radiotherapy

\*SLND=Sentinel Lymph Node
