The impact of surgical technique on the number of sentinel lymph nodes removed and its effect on complication rates

Kathleen Stutz; Holly Mason; Shiva Niakan; Aixa Perez Coulter; Jesse Casaubon; Ann-Kristin U Friedrich

doi:10.1007/s10549-024-07598-y

The impact of surgical technique on the number of sentinel lymph nodes removed and its effect on complication rates

Breast Cancer Res Treat. 2025 Jan 8. doi: 10.1007/s10549-024-07598-y. Online ahead of print.

Authors

Kathleen Stutz¹, Holly Mason², Shiva Niakan³, Aixa Perez Coulter^{4

5}, Jesse Casaubon², Ann-Kristin U Friedrich²

Affiliations

¹ Department of Surgery, Loma Linda University Health, Loma Linda, CA, 923754, USA. kathleen.stutz@gmail.com.
² Department of Surgery, Loma Linda University Health, Loma Linda, CA, 923754, USA.
³ Sutter Gould Medical Foundation - Breast Health and Gynecology, Modesto, CA, 95354, USA.
⁴ Department of Surgery, University of Massachusetts Chan Medical School - Baystate, Springfield, MA, 01199, USA.
⁵ Office of Research, Epidemiology/Biostatistics Research Core, Baystate Medical Center, Springfield, MA, 01199, USA.

PMID: 39776331
DOI: 10.1007/s10549-024-07598-y

Abstract

Purpose: Sentinel lymph node biopsy (SLNB) is a staging procedure used to guide treatment for patients with breast cancer. Multiple variations in the SLNB technique have been described. We questioned how technique impacts the number of sentinel lymph nodes (SLNs) removed and associated complications.

Methods: Patients with breast cancer who were treated with lumpectomy and SLNB between 2018 and 2023 were analyzed. Patients were excluded if they had prior ipsilateral breast or axillary surgery or chest wall radiation, underwent neoadjuvant chemotherapy or endocrine therapy, or subsequently required ALND. Demographics, surgical technique, and operative and pathological data were collected. Complication rates were compared between more (4+) or fewer (1-3) SLNs removed.

Results: A total of 643 patients were included, with an average of 2.44 LNs removed (range 1-11). The overall complication rate was 19.8%, with a 4.4% lymphedema rate. The lymphedema rate was higher among patients who had more nodes removed. An average of 2.5 LNs were removed with dual mapping vs. 2.0 with technetium alone (p = 0.15). Breast massage had no effect on the number of SLNs removed (p = 0.12) but did impact blue dye uptake (p = 0.001).

Conclusions: Surgical technique did not significantly impact the number of nodes removed. Removing more nodes was associated with a greater risk of lymphedema.

Keywords: Breast cancer; Breast massage; Complications; Lymph nodes; Lymphedema; Sentinel lymph node biopsy.