Sentinel Lymph Node Biopsy for Breast Cancer in North Africa: A Retrospective Analysis of Feasibility, Safety, and Morbidity Reduction in a Real-World Setting.

Abstract

Objective: Conventional axillary lymph node dissection (ALND) carries significant morbidity in breast cancer surgery. Sentinel lymph node biopsy (SLNB) offers a less invasive alternative but lacks validation in resource-constrained environments. To compare postoperative morbidity between SLNB and ALND in breast cancer and assess SLNB feasibility.

Materials and methods: A retrospective study was conducted at the Mother-Child Department of Bizerte, Tunisia (January 2022-August 2024). Patients with early-stage breast cancer undergoing SLNB or ALND were included. Primary outcomes were: lymphedema, lymphocele, pain [visual analog scale (VAS)], hemoglobin drop, and length of hospital stay. Statistical analyses were performed using SPSS v26.0. The Student's t-test was used for normally distributed quantitative variables, the Mann-Whitney U test for non-normally distributed variables, and Fisher's exact test for categorical variables with small sample sizes. Normality was assessed using the Shapiro-Wilk test.

Results: Among the 64 included patients, SLNB (n = 26) significantly reduced lymphedema (3.8% vs. 23%, p = 0.039), early postoperative pain (mean VAS: 3.92 vs. 4.7, p = 0.025), and length of hospital stay (5.69 vs. 7.71 days, p = 0.001) compared with ALND (n = 38). Lymphocele incidence was lower but not statistically significant (4% vs. 11; p = 0.640). The SLNB detection rate was 89%.

Conclusion: SLNB significantly reduces postoperative morbidity compared with ALND and is feasible in this resource-limited North African setting. Our findings support its integration into routine breast cancer surgery as a safe and effective alternative to axillary dissection.