Second axillary sentinel node biopsy for ipsilateral breast tumour recurrence.

Area of Science:

• Oncology
• Surgical Oncology
• Radiotherapy

Background:

• Sentinel lymph node biopsy (SLNB) is standard for axillary staging in operable breast cancer.
• Breast-conserving surgery (BCS) is increasingly common, with 5-10% of patients experiencing ipsilateral breast tumor recurrence.
• The utility of a second SLNB after a previous negative SLNB in patients with recurrence is uncertain.

Purpose of the Study:

• To evaluate the safety and efficacy of a second SLNB in patients with ipsilateral breast tumor recurrence after BCS and a prior negative SLNB.
• To determine the rate of sentinel node metastasis detection and axillary recurrence in this patient cohort.

Main Methods:

• A prospective study included 202 patients with ipsilateral breast tumor recurrence after BCS and negative SLNB between 2000-2006.
• 65 women with clinically negative axillary nodes underwent a second SLNB; 57 had received prior adjuvant radiotherapy.
• Preoperative lymphoscintigraphy was used to identify the sentinel node.

Main Results:

• Sentinel node identification was successful in 97% (63/65) of women.
• Metastases were detected in seven women, with two having metastases solely in the second sentinel node.
• No axillary recurrence was observed at a median follow-up of 45.9 months in patients who did not undergo axillary dissection.

Conclusions:

• Second SLNB is a feasible option for selected women with ipsilateral breast tumor recurrence after prior BCS and negative SLNB.
• The procedure can identify further nodal disease and potentially spare patients from complete axillary dissection.
• Adjuvant radiotherapy appears to be compatible with the safety of a second SLNB.