Department of Surgery, William Beaumont Hospital, Royal Oak, MI, USA.
Am J Clin Oncol. 2013 Feb;36(1):20-3. doi: 10.1097/COC.0b013e31823a4956.
PURPOSE: The purpose of the study was to show that delayed axillary lymph node dissection (ALND) has higher rates of lymphedema compared with immediate ALND, using data from NSABP-B32 at Beaumont Hospital. METHOD: NSABP B-32 at Beaumont had 207 patients with follow-up data on 199 patients, randomizing clinically negative axilla to sentinel lymph node biopsy (SLNB)+ALND (GrA N=98), and SLNB+cytology±ALND (GrB N=101). All patients had preoperative volumetric arm measurements and only node negatives had routine postoperative measurements assessing lymphedema for 36 months. We contacted node-positive patients for postoperative measurements for this study. Twenty-four and 15 cytology-positive patients had SLNB+ALND in GrA and GrB, respectively (SubGrA1 N=24; SubGrB1 N=15). Fourteen hematoxylin and eosin-positive patients had delayed ALND (SubGrB2a N=14). RESULTS: Lymphedema rate for node-positive SLNB+ALND was 10.3% [SubGrA1 (3/24)+SubGrB1 (1/15)=4/39] and node-negative SLNB+ALND was 6.8% (SubGrA2=5/74). Lymphedema was 14.3% for delayed ALND in SubGrB2a (2 of 14) and 0% for 72 SLNBs in SubGrB2b. Our study comparing immediate and delayed ALND lymphedema was not statistically significant (10.3% vs. 14.3%, P=0.65). Comparing node-negative ALND (SubGrA2= 5/74=6.8%) to node-positive ALND (A1+B1+B2a=6/53=11.3%) was not statistically significant (P=0.52). Comparing lymphedema for node-negative ALND (SubGrA2) to SLNB (SubGrB2b) only approached significance (6.8% vs. 0%, P=0.058). CONCLUSIONS: The rate of lymphedema was higher in delayed ALND but not statistically significant. Comparison, however, is difficult, given the limited sample size. We urge the other centers of NSABP-B32 to validate this, by contacting the node-positive patients for measurements. The lymphedema rate for SLNB alone was 0% and approached statistical significance when compared with node-negative ALND.
目的：本研究旨在通过 Beaumont 医院 NSABP-B32 的数据表明，与即时腋窝淋巴结清扫术 (ALND) 相比，延迟性 ALND 的淋巴水肿发生率更高。
方法：NSABP-B32 在 Beaumont 医院有 207 例患者的随访数据，其中 199 例患者随机分为经前腋窝临床阴性的前哨淋巴结活检 (SLNB)+ALND（GrA，N=98）和 SLNB+细胞学检查±ALND（GrB，N=101）。所有患者均进行术前容积臂测量，仅对淋巴结阴性患者进行常规术后测量，以评估 36 个月的淋巴水肿情况。为了进行本研究，我们联系了淋巴结阳性患者进行术后测量。GrA 中有 24 例细胞学阳性患者和 GrB 中有 15 例细胞学阳性患者接受了 SLNB+ALND（SubGrA1，N=24；SubGrB1，N=15）。有 14 例苏木精和伊红阳性患者接受了延迟性 ALND（SubGrB2a，N=14）。
结果：淋巴结阳性 SLNB+ALND 的淋巴水肿发生率为 10.3%（SubGrA1，3/24+SubGrB1，1/15=4/39），淋巴结阴性 SLNB+ALND 的淋巴水肿发生率为 6.8%（SubGrA2，5/74）。SubGrB2a 中延迟性 ALND 的淋巴水肿发生率为 14.3%（2/14），SubGrB2b 中 72 例 SLNB 无淋巴水肿。我们对即时性和延迟性 ALND 淋巴水肿的研究无统计学意义（10.3%比 14.3%，P=0.65）。与淋巴结阴性 ALND（SubGrA2，5/74=6.8%）相比，淋巴结阳性 ALND（A1+B1+B2a，6/53=11.3%）无统计学意义（P=0.52）。与淋巴结阴性 ALND（SubGrA2）相比，SLNB（SubGrB2b）仅接近统计学意义（6.8%比 0%，P=0.058）。
结论：延迟性 ALND 的淋巴水肿发生率较高，但无统计学意义。然而，由于样本量有限，比较起来较为困难。我们敦促 NSABP-B32 的其他中心通过联系淋巴结阳性患者进行测量来验证这一点。SLNB 单独的淋巴水肿发生率为 0%，与淋巴结阴性 ALND 相比接近统计学意义。
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