Table 6. Axillary lymph node dissection (ALND) as a risk factor for arm morbidity following breast cancer treatments.
| Disability | Author | N | Follow-up | Measure | Comparison/Comments | P-value | OR/HR | CI (95%) | Type of evidence | Evidence level |
|---|---|---|---|---|---|---|---|---|---|---|
| Lymphedema | Ashikaga 2010 [37] | 3,963 | 36 months | Water displacement | <0.001 | OR = 1.90 | RCT | 1B | ||
| Del Bianco 2007 [82] | 341 | 24 months | ALND vs. SLNB | 0.01 | OR = 0.48 | 0.25–1.06 | RCT | 1B | ||
| Kilbreat 2016 [53] | 450 | 18 months | Circumference and Bioimpedance spectroscopy | >13 lymph nodes | 0.07 | OR = 2.1 | 0.9–4.9 | Prospective cohort study | 2B | |
| Kwan 2010 [49] | 997 | 20.9 months | Examination by a specialist | No. of dissected lymph nodes | HR = 1.04 | 1.02–1.07 | Prospective cohort study | 2B | ||
| Dominick 2013 [61] | 2,431 | 6 years | Norman and colleagues’ validated telephone lymphedema questionnaire | <0.01 | OR = 2.08 | 1.66–2.60 | Prospective cohort study | 2B | ||
| Park 2008 [63] | 450 | 24 months | Tape measure | 0.008 | OR = 6.61 | 1.64–26.57 | Prospective study | 2B | ||
| Kuijer 2021 [17] | 1,037 | 1 year | CARES-SF | <0.01 | OR = 3.6 | Multicenter prospective cohort study | 2B | |||
| Smoot 2010 [104] | 144 | Circumference and bioimpedance | <0.005 | −7.18–-2.43 | Prospective longitudinal study | 2B | ||||
| Sagen 2014 [83] | 391 | 2.5 years | Water Displacement | ALND vs. SLNB | 0.05 | Prospective study | 2B | |||
| Blanchard 2003 [86] | 1,253 | 12 months | Self-reported | ALND vs. SLNB | <0.001 | Prospective study | 2B | |||
| Belmonte 2018 [87] | 112 | 5 years | Circumference | ALND vs. SLNB | <0.001 | 45.8–257.3 | Prospective study | 2B | ||
| Langer 2007 [81] | 635 | 60 months | Circumference | <0.0001 | OR = 0.15 | 0.08–0.28 | Prospective study | 2B | ||
| Zou 2018 [47] | 387 | 24 months | Circumference and Norman questionnaire | 16><16 lymph nodes | 0.09 | HR = 5.2 | 1.6–17.3 | Prospective study | 2B | |
| Yen 2009 [89] | 1,338 | 4 years | Self-reported | More than 5 nodes | <0.001 | OR = 2.11 | 4.68–5.61 | Population cohort study | 2B | |
| Norman 2009 [105] | 631 | 5 years | Self-reported | HR = 2.61 | 1.77–3.84 | Prospective study | 2B | |||
| Chan 2009 [41] | 5 years | Arm circumference | 0.003 | OR = 2.97 | 1.46–6.03 | Matched case-control study | 3B | |||
| Herremans 2021 [43] | 132 | 5 years | Arm circumference and bioimpedance spectroscopy | LYMPHA technique vs. ALND | 0.036 | OR = 0.39 | 0.16–0.94 | Retrospective cross-sectional study | 4 | |
| Owusu 2019 [78] | 313 | - | - | 0.008 | A descriptive retrospective survey | 4 | ||||
| Kim 2013 [79] | 772 | 8.3 years | Circumference measurements | <0.001 | HR = 2.81 | Retrospective study | 4 | |||
| Mccredie 2001 [56] | 809 | Self-report | OR = 2.4 | 1.0–5.6 | Population-based case-control study | 4 | ||||
| Rebegea 2015 [80] | 305 | >25 nodes | <0.001 | OR = 4.88 | 2.25–10.58 | Cross-sectional study | 4 | |||
| 16–25 nodes | <0.001 | OR = 1.85 | 1.27–2.75 | |||||||
| Da Costa Vieira 2016 [3] | 622 | 10 years | Self-report | For ≥ 15 lymph nodes | 0.017 | HR = 9.12 | 1.15–72.12 | Retrospective study | 4 | |
| Ahmed 2011 [71] | 1,287 | Self-report | OR = 3.52 | 1.32–9.34 | Cross-sectional study | 4 | ||||
| Gärtner 2010 [36] | 3,104 | Self-report | <0.0001 | OR = 2.89 | 2.42–3.45 | Cross-sectional study | 4 | |||
| Crosby 2012 [58] | 1,117 | From medical records | <0.001 | OR = 6.69 | 2.59–17.29 | Retrospective study | 4 | |||
| Meeske 2009 [35] | 494 | 50 months | Self-report of lymphedema | 10 or more lymph nodes | OR = 2.16 | 1.12–4.17 | A case-control study | 4 | ||
| Langer 2007 [81] | 635 | 60 months | VAS | <0.0001 | OR = 0.33 | 0.20–0.54 | Prospective study | 2B | ||
| Persistent pain | Kramer 2019 [73] | 349 | SPADI questionnaire | OR = 0.48 | 0.23–0.98 | Cross-sectional study | 4 | |||
| Mejdahl 2013 [27] | 2,411 | Developed questionnaire | <0.001 | OR = 2.04 | 1.60–2.61 | Cross-sectional study | 4 | |||
| Chiang 2019 [74] | 201 | NPRS and Brief Pain Inventory | 0.03 | OR = 4.33 | 1.19–15.73 | Retrospective cross-sectional study | 4 | |||
| Functional disabilities | Del Bianco 2007 [82] | 341 | 24 months | - | ALND vs. SLNB at 6 months | 0.005 | OR = 0.47 | 0.27–0.79 | RCT | 1B |
| Habib 2020 [92] | 44 | 6 weeks | QuickDASH disability score | 0.010 | Prospective cohort | 2B | ||||
| Hayes 2010 [39] | 287 | 18 months | QuickDASH and Functional Assessment of Cancer Therapy Breast questionnaire | 0.02 | OR = 4.81 | 1.64–14.14 | Prospective study | 2B | ||
| Kramer 2019 [73] | 349 | SPADI questionnaire | OR = 0.99 | 0.54–1.81 | Cross-sectional study | 4 | ||||
| Decreased range of motion | Ashikaga 2010 [37] | 3,963 | 36 months | <0.001 | OR = 1.54 | RCT | 1B | |||
| Nesvold 2008 [48] | 263 | 47 months | British Columbia Cancer Agency in Canada | 0.01 | OR = 0.92 | 0.85–0.98 | Prospective study | 2B | ||
| Langer 2007 [81] | 635 | 60 months | ROM measurements | 0.0002 | OR = 0.22 | 0.15–0.56 | Prospective study | 2B | ||
| Hack 2010 [59] | 316 | 12 months | Volume measurements | 0.003 | OR = 3.62 | 8.48–1.54 | Cross-sectional study | 4 | ||
| Ahmed 2011 [71] | 1,287 | Self-report | OR = 2.38 | 1.41–4.03 | Cross-sectional study | 4 |
Abbreviations: N: number; CI: confidence interval; OR: odds ratio; HR: hazard ratio; ALND: axillary lymph node dissection; SLNB: sentinel lymph node biopsy; VAS: visual analog scale; ROM: range of motion; RCT: randomize control trail.