The risk of axillary relapse after sentinel lymph node biopsy for breast cancer is comparable with that of axillary lymph node dissection: A follow-up study of 4008 procedures Journal Article


Authors: Naik, A. M.; Fey, J.; Gemignani, M.; Heerdt, A.; Montgomery, L.; Petrek, J.; Port, E.; Sacchini, V.; Sclafani, L.; Van Zee, K.; Wagman, R.; Borgen, P. I.; Cody, H. S. 3rd
Article Title: The risk of axillary relapse after sentinel lymph node biopsy for breast cancer is comparable with that of axillary lymph node dissection: A follow-up study of 4008 procedures
Abstract: Objective: We sought to identify the rate of axillary recurrence after sentinel lymph node (SLN) biopsy for breast cancer. Summary Background Data: SLN biopsy is a new standard of care for axillary lymph node staging in breast cancer. Nevertheless, most validated series of SLN biopsy confirm that the SLN is falsely negative in 5-10% of node-positive cases, and few studies report the rate of axillary local recurrence (LR) for that subset of patients staged by SLN biopsy alone. Methods: Through December of 2002, 4008 consecutive SLN biopsy procedures were performed at Memorial Sloan-Kettering Cancer Center for unilateral invasive breast cancer. Patients were categorized in 4 groups: SLN-negative with axillary lymph node dissection (ALND; n = 326), SLN-negative without ALND (n = 2340), SLN-positive with ALND (n = 1132), and SLN-positive without ALND (n = 210). Clinical and pathologic characteristics and follow-up data for each of the 4 cohorts were evaluated with emphasis on patterns of axillary LR. Results: With a median follow-up of 31 months (range, 1-75), axillary LR occurred in 10/4008 (0.25%) patients overall. In 3 cases (0.07%) the axillary LR was the first site of treatment failure, in 4 (0.1%) it was coincident with breast LR, and in 3 (0.07%) it was coincident with distant metastases. Axillary LR was more frequent among the unconventionally treated SLN-positive/no ALND patients than in the other 3 conventionally treated cohorts (1.4% versus 0.18%, P = 0.013). Conclusions: Axillary LR after SLN biopsy, with or without ALND, is a rare event, and this low relapse rate supports wider use of SLN biopsy for breast cancer staging. There is a low-risk subset of SLN-positive patients in whom completion ALND may not be required.
Keywords: adult; middle aged; treatment failure; major clinical study; cancer recurrence; conference paper; comparative study; cancer staging; follow up; follow-up studies; lymph node dissection; lymphatic metastasis; lymph node excision; sentinel lymph node biopsy; metastasis; neoplasm recurrence, local; breast cancer; risk factors; breast neoplasms; risk assessment; axillary lymph node; axilla; humans; human; female; priority journal
Journal Title: Annals of Surgery
Volume: 240
Issue: 3
ISSN: 0003-4932
Publisher: Lippincott Williams & Wilkins  
Date Published: 2004-09-01
Start Page: 462
End Page: 471
Language: English
DOI: 10.1097/01.sla.0000137130.23530.19
PROVIDER: scopus
PMCID: PMC1356436
PUBMED: 15319717
DOI/URL:
Notes: Ann. Surg. -- Cited By (since 1996):279 -- Export Date: 16 June 2014 -- CODEN: ANSUA -- Source: Scopus
Altmetric
Citation Impact
MSK Authors
  1. Jeanne Ann Petrek
    91 Petrek
  2. Kimberly J Van Zee
    279 Van Zee
  3. Hiram S Cody III
    235 Cody
  4. Mary L Gemignani
    190 Gemignani
  5. Elisa Port
    45 Port
  6. Virgilio Sacchini
    112 Sacchini
  7. Alexandra S Heerdt
    104 Heerdt
  8. Arpana M Naik
    5 Naik
  9. Patrick I Borgen
    253 Borgen
  10. Jane Fey
    66 Fey