Repeated sentinel lymph node biopsy for local recurrence after breast-conserving surgery

Area of Science:

• Surgical Oncology
• Breast Cancer Management
• Nuclear Medicine in Oncology

Background:

• Sentinel lymph node biopsy (SNB) is standard for early breast cancer, enabling omission of axillary lymph node dissection (Ax) while maintaining axillary control.
• Ipsilateral breast tumor recurrence (IBTR) necessitates further management strategies.
• Evaluating repeat SNB (reSNB) is crucial for patients with IBTR.

Purpose of the Study:

• To assess the efficacy and safety of repeat sentinel lymph node biopsy (reSNB) in patients with ipsilateral breast tumor recurrence (IBTR).
• To determine the identification rate of reSNB in the axilla.
• To evaluate the oncologic outcomes, including metastasis and local recurrence, following reSNB.

Main Methods:

• Retrospective analysis of 52 patients undergoing reSNB for IBTR between June 2012 and March 2019.
• reSNB performed using both dye and radioactive isotope methods.
• Identification rate calculated as visualized SLNs divided by total cases, compared by initial surgical procedure.

Main Results:

• Overall reSNB identification rate was 94.2%.
• Higher identification rates for reSNB in patients initially treated with SNB versus axillary lymph node dissection (83.3% vs. 42.9%).
• Three patients (6.7%) had positive reSNB in the ipsilateral axilla; no metastasis in contralateral axilla or internal mammary region. No local recurrence observed in the ipsilateral axillary region post-reoperation.

Conclusions:

• reSNB achieves high identification rates, comparable to initial SNB, in IBTR cases.
• reSNB demonstrates a low rate of positive metastasis and effectively prevents local recurrence in the ipsilateral axillary region.
• Findings suggest reSNB is clinically significant for managing IBTR, despite the limited sample size.