R.M.H. Roumen

Risk, severity and predictors of physical and psychological morbidity after axillary lymph node dissection for breast cancer

The aim of this study was to investigate the nature and severity of the arm complaints among breast cancer patients after axillary lymph node dissection (ALND) and to study the effects of this treatment-related morbidity on daily life and well-being. 400 women, who underwent ALND as part of breast cancer surgery, filled out a treatment-specific quality of life questionnaire. The mean time since ALND was 4.7 years (range 0.3-28 years). More than 20% of patients reported pain, numbness, or loss of strength and 9% reported severe oedema. None of the complaints appeared to diminish over time. Irradiation of the axilla and supraclavicular irradiation were associated with a 3.57-fold higher risk of oedema (odds ratio (OR) 3.57; 95% confidence interval (CI) 1.66-7.69) causing many patients to give up leisure activities or sport. Women who underwent irradiation of the breast or chest wall more often reported to have a sensitive scar than women who did not receive radiotherapy. Women <45 years of age had an approximately 6 times higher risk of numbness of the arm (OR 6.49; 95% CI 2.58-16.38) compared with those > or = 65 years of age; they also encountered more problems doing their household chores. The results of the present study support the introduction of less invasive techniques for the staging of the axilla, sentinel node biopsy being the most promising.

Lymphoscintigraphy and feasibility of sentinel node biopsy in 83 patients with primary breast cancer

Sentinel node (SN) biopsy technique has been reported to be a very accurate staging procedure in patients with stage I/II melanoma. Whether it is as accurate in patients with breast cancer has to be studied more extensively. Eighty-three patients with clinically T1-T2 N0M0 breast cancer were peri-tumorally injected with 99m-Tc colloidal-albumin. Lymphoscintigraphy was performed either 4 or 18 h after the injection. Using a gamma probe the SN were located in vivo, removed from the axillary specimen and sent for histological examination. No focal accumulation was seen on the lymphoscintigraphy in 17 patients. Two patients had parasternal SN locations only and in seven patients the localization of the SN failed. Of the remaining 57 patients, 23 had positive axillary basins, of which 22 were correctly predicted by one or more positive SN. There was one false-negative biopsy (sensitivity=96%). In 12 of the 22 positive axillary basins, SN was the only positive node. We conclude that the SN biopsy technique is a promising and feasible procedure in about three-quarters of patients with clinically T1-T2 N0M0 breast cancer. However, more data are needed to establish the actual sensitivity of this procedure.

Lymphoedema and reduced shoulder function as indicators of quality of life after axillary lymph node dissection for invasive breast cancer.

The aim was to explore measurements of arm circumference and shoulder abduction as indicators of quality of life after axillary lymph node dissection for invasive breast cancer.

Changing attitudes towards breast-conserving treatment of early breast cancer in the south-eastern Netherlands : results of a survey among surgeons and a registry-based analysis of patterns of care

To see whether personal preferences of surgeons can explain the trends in the use of breast-conserving therapy (BCT) of early breast cancer, questionnaires were sent to the surgeons of seven community hospitals in the south-eastern Netherlands in 1987 and 1995. The answers were set against the actual use of breast-conserving therapy in the hospitals in the period 1984-94, as monitored by the Eindhoven Cancer Registry. The proportion of surgeons who were willing to use BCT for tumours < or =3 cm increased from 43% in 1987 to 93% in 1995. In 1995, the majority of the surgeons considered multicentric tumour growth, diffuse microcalcifications on the mammogram and an extensive intraductal component around the tumour as contraindications for breast-conserving therapy. The proportion of patients with an operable, non-metastasized breast tumour of < or =5 cm in diameter undergoing breast-conservative surgery increased from 31% in 1984 to 60% in 1989 (P<0.01) and remained at that level in 1990 and 1991. Between 1991 and 1993, the proportion receiving breast-conservative surgery decreased significantly for patients younger than 50 years and a tumour 2.1-3.0cm in diameter, and also for those 50-69 years old with a tumour < or =2.0cm or 3.1-5.0cm across. The observed decrease in BCT in the south-eastern Netherlands in some subgroups seems to reflect the growing awareness of potential risk factors for local recurrence following BCT.