Sentinel lymph node biopsy results in less postoperative morbidity compared with axillary lymph node dissection for breast cancer William E. Burak, Jr., M.D. a, *, Scott T. Hollenbeck, M.D. b , Emmanuel E. Zervos, M.D. a , Karen L. Hock, M.S.P.T. b , Lisa C. Kemp, R.N., C.N.P. a , Donn C. Young, Ph.D. c a Division of Surgical Oncology, Department of Surgery, Ohio State University, N914 Doan Hall, 410 W. 10th Ave., Columbus, OH 43210, USA b Department of Surgery, Ohio State University, Columbus, OH, USA c Biostatistics Core, Comprehensive Cancer Center, James Cancer Hospital and Solove Research Institute, College of Medicine and Public Health, Ohio State University, Columbus, OH, USA Manuscript received April 6, 2001; revised manuscript September 2, 2001 Abstract Background: This study was designed to compare the postoperative morbidity and socioeconomic impact of sentinel lymph node biopsy (SLNB) with axillary lymph node dissection (ALND) in patients with early stage breast cancer. Methods: A prospective, nonrandomized, controlled study was designed to include patients who underwent breast conservation surgery and SLNB  ALND. Group A consisted of patients who had a negative SLNB and did not go on to completion ALND. Group B consisted of patients who underwent a SLNB followed by a completion ALND because either (1) their sentinel node contained cancer or (2) they were within the validation phase of our institution’s sentinel lymph node protocol. Patients were evaluated with a questionnaire and underwent a standardized physical examination to determine arm circumference. Results: Data were obtained from 96 patients with a mean follow-up period of 15 months (range 8 to 29). Significant differences were seen in subjective measurements of arm complaints and arm numbness (P 0.001), with fewer complaints reported in group A. The difference in mid-bicep and antecubital fossa circumferences was significant when comparing the ratio of the procedure arm with the nonprocedure arm and when subtracting the nonprocedure arm from the procedure arm (P 0.003 and P 0.016, respectively) in favor of group A. Axillary surgery was performed as an outpatient procedure in 88% of group A patients, compared with 15% in group B (P 0.001). Furthermore, 71% of group A patients returned to “normal activity” in less than 4 days, in comparison with 7% of group B (P 0.001). Conclusions: SLNB results in less postoperative morbidity in terms of subjective arm complaints and mid-arm swelling. Expeditious return to work or normal activity after SLNB has potentially significant socioeconomic consequences. © 2002 Excerpta Medica, Inc. All rights reserved. Keywords: Breast; Sentinel; Lymphedema The morbidity of axillary lymph node dissection for breast cancer has been well documented. Short-term complications such as wound infection, seroma, and limited arm move- ment are generally easily managed and infrequently lead to permanent disability. More disabling are the long-term complications, such as lymphedema, arm numbness, and chronic pain, which range in frequency from 25% to 30% [1– 4]. Lymphatic mapping and sentinel lymph node biopsy is being offered as an alternative to axillary lymph node dis- section in both academic and community settings [5,6]. The rationale for sentinel node biopsy is that patients with patho- logically-negative axillary nodes can be spared the morbid- ity of a diagnostic axillary lymph node dissection, as the majority of patients with invasive breast cancer have unin- volved nodes. Shorter hospital stays, fewer wound compli- cations, and less long-term disability have also been sug- gested as potential advantages. However, because sentinel lymph node biopsy is a relatively recent development in the treatment of breast cancer, there is a paucity of data sup- porting these claims. In addition, economic issues, such as expense and return to normal activity, have become much more carefully scrutinized, particularly in the present med- ical climate. In most centers, those patients undergoing * Corresponding author. Tel.: +1-614-293-7743; fax: +1614-293- 3465. E-mail address: Burak.1@osu.edu The American Journal of Surgery 183 (2002) 23–27 0002-9610/02/$ – see front matter © 2002 Excerpta Medica, Inc. All rights reserved. PII: S0002-9610(01)00848-0