Using the intraoperative hand held probe without lymphoscintigraphy or using only dye correlates with higher sensory morbidity following sentinel lymph node biopsy in breast cancer

A review of the literature

Suk Chul Kim, Dong Wook Kim, Renee M. Moadel, Chun K. Kim, Samprit Chatterjee, Michail K. Shafir, Arlene Travis, Josef Machac, Borys R. Krynyckyi

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background: There are no studies that have directly investigated the incremental reduction in sensory morbidity that lymphoscintigraphy images (LS) and triangulated body marking or other skin marking techniques provide during sentinel lymph node biopsy (SLNB) compared to using only the probe without LS and skin marking or using only dye. However, an indirect assessment of this potential for additional sensory morbidity reduction is possible by extracting morbidity data from studies comparing the morbidity of SLNB to that of axillary lymph node dissection. Methods: A literature search yielded 20 articles that had data on sensory morbidity at specific time points on pain, numbness or paresthesia from SLNB that used radiotracer and probe or used only dye as a primary method of finding the sentinel node (SN). Of these, 17 utilized LS, while 3 did not utilize LS. By matching the data in studies not employing LS to the studies that did, comparisons regarding the percentage of patients experiencing pain, numbness/paresthesia after SLNB could be reasonably attempted at a cutoff of 9 months. Results: In the 7 studies reporting on pain after 9 months (>9 months) that used LS (1347 patients), 13.8% of patients reported these symptoms, while in the one study that did not use LS (143 patients), 28.7% of patients reported these symptoms at >9 months (P<0.0001). In the 6 studies reporting on numbness and/or paresthesia at >9 months that used LS (601 patients), 12.5% of patients reported these symptoms, while in the 3 studies that did not use LS (229 patients), 23.1% of patients reported these symptoms at >9 months (P=0.0002). Similar trends were also noted for all these symptoms at ≤ 9 months. Conclusion: Because of variations in techniques and time of assessing morbidity, direct comparisons between studies are difficult. Nevertheless at a minimum, a clear trend is present: having the LS images and skin markings to assist during SLNB appears to yield more favorable morbidity outcomes for the patients compared to performing SLNB with only the probe or performing SLNB with dye alone. These results are extremely pertinent, as the main reason for performing SLNB itself in the first place is to achieve reduced morbidity.

Original languageEnglish (US)
Article number64
JournalWorld Journal of Surgical Oncology
Volume3
DOIs
StatePublished - Sep 29 2005

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Lymphoscintigraphy
Sentinel Lymph Node Biopsy
Coloring Agents
Hand
Breast Neoplasms
Morbidity
Hypesthesia
Paresthesia
Pain
Skin
Body Image
Lymph Node Excision

ASJC Scopus subject areas

  • Cancer Research
  • Surgery

Cite this

Using the intraoperative hand held probe without lymphoscintigraphy or using only dye correlates with higher sensory morbidity following sentinel lymph node biopsy in breast cancer : A review of the literature. / Kim, Suk Chul; Kim, Dong Wook; Moadel, Renee M.; Kim, Chun K.; Chatterjee, Samprit; Shafir, Michail K.; Travis, Arlene; Machac, Josef; Krynyckyi, Borys R.

In: World Journal of Surgical Oncology, Vol. 3, 64, 29.09.2005.

Research output: Contribution to journalArticle

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abstract = "Background: There are no studies that have directly investigated the incremental reduction in sensory morbidity that lymphoscintigraphy images (LS) and triangulated body marking or other skin marking techniques provide during sentinel lymph node biopsy (SLNB) compared to using only the probe without LS and skin marking or using only dye. However, an indirect assessment of this potential for additional sensory morbidity reduction is possible by extracting morbidity data from studies comparing the morbidity of SLNB to that of axillary lymph node dissection. Methods: A literature search yielded 20 articles that had data on sensory morbidity at specific time points on pain, numbness or paresthesia from SLNB that used radiotracer and probe or used only dye as a primary method of finding the sentinel node (SN). Of these, 17 utilized LS, while 3 did not utilize LS. By matching the data in studies not employing LS to the studies that did, comparisons regarding the percentage of patients experiencing pain, numbness/paresthesia after SLNB could be reasonably attempted at a cutoff of 9 months. Results: In the 7 studies reporting on pain after 9 months (>9 months) that used LS (1347 patients), 13.8{\%} of patients reported these symptoms, while in the one study that did not use LS (143 patients), 28.7{\%} of patients reported these symptoms at >9 months (P<0.0001). In the 6 studies reporting on numbness and/or paresthesia at >9 months that used LS (601 patients), 12.5{\%} of patients reported these symptoms, while in the 3 studies that did not use LS (229 patients), 23.1{\%} of patients reported these symptoms at >9 months (P=0.0002). Similar trends were also noted for all these symptoms at ≤ 9 months. Conclusion: Because of variations in techniques and time of assessing morbidity, direct comparisons between studies are difficult. Nevertheless at a minimum, a clear trend is present: having the LS images and skin markings to assist during SLNB appears to yield more favorable morbidity outcomes for the patients compared to performing SLNB with only the probe or performing SLNB with dye alone. These results are extremely pertinent, as the main reason for performing SLNB itself in the first place is to achieve reduced morbidity.",
author = "Kim, {Suk Chul} and Kim, {Dong Wook} and Moadel, {Renee M.} and Kim, {Chun K.} and Samprit Chatterjee and Shafir, {Michail K.} and Arlene Travis and Josef Machac and Krynyckyi, {Borys R.}",
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T2 - A review of the literature

AU - Kim, Suk Chul

AU - Kim, Dong Wook

AU - Moadel, Renee M.

AU - Kim, Chun K.

AU - Chatterjee, Samprit

AU - Shafir, Michail K.

AU - Travis, Arlene

AU - Machac, Josef

AU - Krynyckyi, Borys R.

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Y1 - 2005/9/29

N2 - Background: There are no studies that have directly investigated the incremental reduction in sensory morbidity that lymphoscintigraphy images (LS) and triangulated body marking or other skin marking techniques provide during sentinel lymph node biopsy (SLNB) compared to using only the probe without LS and skin marking or using only dye. However, an indirect assessment of this potential for additional sensory morbidity reduction is possible by extracting morbidity data from studies comparing the morbidity of SLNB to that of axillary lymph node dissection. Methods: A literature search yielded 20 articles that had data on sensory morbidity at specific time points on pain, numbness or paresthesia from SLNB that used radiotracer and probe or used only dye as a primary method of finding the sentinel node (SN). Of these, 17 utilized LS, while 3 did not utilize LS. By matching the data in studies not employing LS to the studies that did, comparisons regarding the percentage of patients experiencing pain, numbness/paresthesia after SLNB could be reasonably attempted at a cutoff of 9 months. Results: In the 7 studies reporting on pain after 9 months (>9 months) that used LS (1347 patients), 13.8% of patients reported these symptoms, while in the one study that did not use LS (143 patients), 28.7% of patients reported these symptoms at >9 months (P<0.0001). In the 6 studies reporting on numbness and/or paresthesia at >9 months that used LS (601 patients), 12.5% of patients reported these symptoms, while in the 3 studies that did not use LS (229 patients), 23.1% of patients reported these symptoms at >9 months (P=0.0002). Similar trends were also noted for all these symptoms at ≤ 9 months. Conclusion: Because of variations in techniques and time of assessing morbidity, direct comparisons between studies are difficult. Nevertheless at a minimum, a clear trend is present: having the LS images and skin markings to assist during SLNB appears to yield more favorable morbidity outcomes for the patients compared to performing SLNB with only the probe or performing SLNB with dye alone. These results are extremely pertinent, as the main reason for performing SLNB itself in the first place is to achieve reduced morbidity.

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