Review article (Meta-analysis)
Incidence and Time Path of Lymphedema in Sentinel Node Negative Breast Cancer Patients: A Systematic Review

https://doi.org/10.1016/j.apmr.2015.01.014Get rights and content

Abstract

Objective

To systematically assess the incidence/prevalence and time path of lymphedema in patients with sentinel node–negative breast cancer.

Data Sources

A systematic literature search up to November 2013 was performed using 4 different electronic databases: PubMed, Embase, Cochrane Clinical Trials, and Web of Science.

Study Selection

Inclusion criteria were as follows: (1) research studies that included breast cancer patients who were surgically treated using the sentinel lymph node biopsy (SLNB) technique; (2) sentinel node–negative patients; (3) studies that investigated lymphedema as a primary or secondary outcome; (4) data extraction for the incidence or time path of lymphedema was possible; and (5) publication date starting from January 1, 2001. Exclusion criteria were as follows: (1) reviews or case studies; (2) patients who had an SLNB followed by an axillary lymph node dissection (ALND); (3) results of ALND patients and SLNB patients 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

Twenty-eight articles were included, representing 9588 SLNB-negative patients. The overall incidence of lymphedema in patients with sentinel node–negative breast cancer 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 postsurgery of 3.2% to 5%, 2% to 10%, 3% to 63.4%, 6.6% to 7%, and 6.9% to 8.2%, respectively.

Conclusions

In SLNB patients, lymphedema is still a problem, mostly occurring 6 to 12 months after surgery. Because of different assessments and criteria, there is a wide range in incidence. Clear definitions of lymphedema are absolutely necessary to tailor therapy.

Section snippets

Methods

The literature was systematically reviewed, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, addressing the following research questions mentioned above. Four electronic databases were screened online to identify eligible studies: PubMed (October 14, 2013), Web of Science (October 22, 2013), Embase (October 23, 2013), and Cochrane Clinical Trials (October 29, 2013). In order to retrieve eligible studies, Medical Subject Headings and keywords were

Results

Initially the search yielded 635 citations. After the first screening and removal of duplicates, 96 full-text articles were retrieved. After the final screening based on the full texts, 28 studies6, 8, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35 were found eligible and included in this review. The results of this systematic review are based on 21 cohort studies,8, 14, 15, 16, 17, 18, 19, 20, 22, 23, 24, 25, 26, 27, 28, 29, 30, 32, 33, 34

Discussion

The results of our systematic review clearly demonstrate that lymphedema is a nonnegligible complication in patients with SLNB-negative breast cancer. The overall range of the lymphedema incidence (0%–63.4%) is very broad. Two studies11, 15 are mainly responsible for this broad range. Both studies have clear limitations, and their results should be appraised critically with regard to the incidences found. Armer et al11 reported on a very low number (n=9) of SLNB patients, of whom 2 (22%)

Conclusions

In patients who have had SLNB, lymphedema is still a problem, usually occurring 6 to 12 months after surgery. Because different assessments and criteria have been used for lymphedema, there is a wide range of reported incidence rates. Clear definitions of lymphedema are absolutely necessary to tailor therapy.

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    Supported by the Flemish Government academic fund (grant no. G817-g091).

    Disclosures: none.

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