Reoperative sentinel lymph node biopsy: A new frontier in the management of ipsilateral breast tumor recurrence Journal Article
| Authors: | Port, E. R.; Garcia-Etienne, C. A.; Park, J.; Fey, J.; Borgen, P. I.; Cody, H. S. 3rd |
| Article Title: | Reoperative sentinel lymph node biopsy: A new frontier in the management of ipsilateral breast tumor recurrence |
| Abstract: | Background: Breast conservation therapy (BCT) with sentinel lymph node (SLN) biopsy is a well-established standard of care for primary operable breast cancer; 5-10% of BCT patients will develop local recurrence (LR). The question then arises: How best to manage the axilla in the setting of LR after previous BCT and SLN biopsy or axillary dissection (ALND)? Methods: Between 9/96 and 12/04, 117 reoperative SLN were performed for LR after BCT and either SLN biopsy or ALND more than 6 months previously. Because of wide variation in the number of nodes removed at the initial procedure, validation by backup ALND was not feasible in all cases. Results: Reoperative SLN was successful in 64/117 (55%) patients. SLNs were identified by isotope and dye in 28/64 (44%); isotope only in 29/64 (45%); dye only in 4/64 (6%); 3/64 (5%) unknown. Positive reoperative SLN were found in 10/64 (16%) successful cases. Among 54/64 (84%) patients with negative reoperative SLNs, 23 (43%) had additional non-SLN removed concurrently: these were negative in 21/23 cases (91%). In 2/23 (9%), reoperative SLN were falsely negative: one with a positive intramammary node, and the other with a positive non-SLN palpated at surgery. Success of reoperative SLN was inversely related to number of nodes removed previously, and was more likely to be successful after a previous SLN biopsy than a previous ALND (74% vs. 38%, P = 0.0002). Non-axillary drainage was identified by lymphoscintigraphy significantly more often in reoperative SLN than in primary SLN biopsy (30% vs. 6%, P < 0.0001). There were no local or axillary recurrences at a mean follow up of 2.2 years; 6 patients developed systemic recurrence. Conclusions: Reoperative SLN biopsy is feasible in the setting of LR after previous BCT/axillary surgery and deserves further study in this increasingly common clinical scenario. The added benefit of lymphoscintigraphy in identifying sites of non-axillary drainage may be greater in the setting of reoperative SLN than for the initial SLN procedure. © 2007 Society of Surgical Oncology. |
| Keywords: | adult; human tissue; aged; aged, 80 and over; middle aged; retrospective studies; major clinical study; validation process; recurrent cancer; follow up; lymph node dissection; lymphatic metastasis; lymphoscintigraphy; sentinel lymph node biopsy; neoplasm recurrence, local; breast neoplasms; biopsy; false negative result; axillary lymph node; feasibility study; statistical significance; feasibility studies; conservative treatment; breast tumor; reoperation; dye; axilla; isotope; radionuclide imaging; tissue preservation; breast conservation; local recurrence; drain; reoperative sentinel lymph node biopsy |
| Journal Title: | Annals of Surgical Oncology |
| Volume: | 14 |
| Issue: | 8 |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Date Published: | 2007-08-01 |
| Start Page: | 2209 |
| End Page: | 2214 |
| Language: | English |
| DOI: | 10.1245/s10434-006-9237-z |
| PUBMED: | 17268882 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 42" - "Export Date: 17 November 2011" - "CODEN: ASONF" - "Source: Scopus" |
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