Long-Term Morbidity of Sentinel Node Biopsy Versus Complete Axillary Dissection for Unilateral Breast Cancer Rebecca Crane-Okada, PhD, 1,2 Robert A. Wascher, MD, 3 David Elashoff, PhD, 4 and Armando E. Giuliano, MD 1 1 Department of Surgical Oncology, John Wayne Cancer Institute at Saint John’s Health Center, Santa Monica, CA, USA 2 City of Hope National Medical Center, 1500 E. Duarte Blvd., Duarte, CA, USA 3 Division of Surgical Oncology, Department of Surgery, Newark Beth Israel Medical Center, Newark, NJ, USA 4 Departments of Medicine and Biostatistics, University of California, Los Angeles, CA, USA Background: Postoperative changes after axillary lymph node surgery may significantly alter breast cancer survivors’ (BCS) quality of life. Although sentinel lymph node biopsy (SLNB) has less immediate morbidity than axillary lymph node dissection (ALND), its long- term impact on shoulder abduction, arm swelling, and neurosensory changes has not been evaluated. The purpose of this study was to compare long-term morbidity after SLNB or ALND and breast-conservation surgery. Methods: Female BCS who remained free of disease at least 3 years after ALND or SLNB for Stage I–III unilateral breast cancer completed a symptom questionnaire and a brief neu- rosensory physical examination of the upper arm and axilla (range of motion, arm circum- ference, and sensation to light touch with cotton and needle). Results: The mean age of the 187 participating BCS was 62 years. At a mean follow-up of 6.6 years after ALND and 4.9 years after SLNB, most BCS had full abduction; only 10 cases (8 ALND, 2 SLNB) had a ‡2 cm proximal and/or distal circumference difference on the ipsilateral side compared with the contralateral side. ALND was associated with a significantly greater likelihood of subjective arm numbness (P \ .001), chest or axillary numbness (P \ .001), arm or hand swelling (P \ .001), and objective neurosensory changes in the posterior axilla, medial and distal upper arm (P \ .001). Operative procedure was the only significant predictor of neurosensory changes (P \ .001). Conclusion: SLNB is associated with significantly less subjective and objective long-term morbidity than ALND. Key Words: Breast cancer—Sentinel node—Symptoms—Quality of life. In patients with clinically localized breast cancer, accurate assessment of regional lymph nodes is essen- tial for staging and management. However, axillary lymph node dissection (ALND) is associated with acute and chronic postoperative changes that may significantly affect quality of life. 1–8 Pain after ALND in breast cancer most often reflects transection of or injury to the intercostobrachial cutaneous nerves (ICBN) that provide sensation predominantly to the shoulder and upper inner arm. Although many women will experience temporary paresthesias in the affected arm, the loss of ICBN innervation may result in per- manent numbness. In the majority of cases, the sen- sation of numbness that remains is not particularly noticeable. However, chronic symptoms may persist, continuously or intermittently, causing discomfort and distress. Even if the disrupted nerves regenerate, causing some sensation to be regained, aberrant nerve regeneration may result in chronic symptoms. Published online April 16, 2008. Address correspondence and reprint requests to: Rebecca Crane-Okada, PhD; E-mail: rcrane-okada@coh.org Published by Springer Science+BusinessMedia, LLC Ó 2008 The Society of Surgical Oncology, Inc. Annals of Surgical Oncology 15(7):1996–2005 DOI: 10.1245/s10434-008-9909-y 1996