Sentinel Lymph Node Dissection in Locally Recurrent Breast Cancer

TY - JOUR

T1 - Sentinel Lymph Node Dissection in Locally Recurrent Breast Cancer

AU - Uth, Charlotte Caspara

AU - Christensen, Mette Haulund

AU - Oldenbourg, Mette Holmqvist

AU - Kjær, Christina

AU - Garne, Jens Peter

AU - Teilum, Dorthe

AU - Kroman, Niels

AU - Tvedskov, Tove Holst Filtenborg

PY - 2015/8/1

Y1 - 2015/8/1

N2 - BACKGROUND: The aim of this study was to investigate the use of sentinel lymph node dissection (SLND) in the treatment of patients with locally recurrent breast cancer.METHODS: A total of 147 patients with locally recurrent breast cancer were included from five different breast surgery departments in Denmark. Data on previous breast and axillary surgery, adjuvant treatment, second operation in the breast and axilla, and lymphoscintigraphy were collected retrospectively from the original patient files.RESULTS: SLND after recurrence (SLNDAR) was successful in 72 of 144 patients (50 %). The detection rate was significantly higher after previous SLND (66 %) compared with previous ALND (34 %) [p = 0.0001]. Thirty-seven patients (51 %) who had previous SLND had a negative sentinel node. These patients could be spared an ALND. Six patients (8 %) who had a previous ALND had a metastatic sentinel node at recurrence; 17 % of patients had a sentinel node located outside the ipsilateral axilla; and eight patients with negative sentinel node at SLNDAR underwent completion ALND. None of these patients had metastases at completion ALND, corresponding to a false negative rate of 0 %.CONCLUSIONS: SLNDAR seems to be a feasible procedure in locally recurrent breast cancer and can spare a clinically significant number of patients an unnecessary ALND and the following risk of sequelae. In patients who had previous ALND, SLNDAR identified metastases that would have been overlooked following the current guidelines. A large proportion of patients had aberrant drainage, suggesting a need for lymphoscintigraphy.

AB - BACKGROUND: The aim of this study was to investigate the use of sentinel lymph node dissection (SLND) in the treatment of patients with locally recurrent breast cancer.METHODS: A total of 147 patients with locally recurrent breast cancer were included from five different breast surgery departments in Denmark. Data on previous breast and axillary surgery, adjuvant treatment, second operation in the breast and axilla, and lymphoscintigraphy were collected retrospectively from the original patient files.RESULTS: SLND after recurrence (SLNDAR) was successful in 72 of 144 patients (50 %). The detection rate was significantly higher after previous SLND (66 %) compared with previous ALND (34 %) [p = 0.0001]. Thirty-seven patients (51 %) who had previous SLND had a negative sentinel node. These patients could be spared an ALND. Six patients (8 %) who had a previous ALND had a metastatic sentinel node at recurrence; 17 % of patients had a sentinel node located outside the ipsilateral axilla; and eight patients with negative sentinel node at SLNDAR underwent completion ALND. None of these patients had metastases at completion ALND, corresponding to a false negative rate of 0 %.CONCLUSIONS: SLNDAR seems to be a feasible procedure in locally recurrent breast cancer and can spare a clinically significant number of patients an unnecessary ALND and the following risk of sequelae. In patients who had previous ALND, SLNDAR identified metastases that would have been overlooked following the current guidelines. A large proportion of patients had aberrant drainage, suggesting a need for lymphoscintigraphy.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Axilla

KW - Breast Neoplasms

KW - Dissection

KW - Female

KW - Humans

KW - Lymph Node Excision

KW - Lymph Nodes

KW - Lymphatic Metastasis

KW - Middle Aged

KW - Neoplasm Recurrence, Local

KW - Reoperation

KW - Retrospective Studies

KW - Sentinel Lymph Node Biopsy

U2 - 10.1245/s10434-014-4338-6

DO - 10.1245/s10434-014-4338-6

M3 - Journal article

C2 - 25564177

SN - 1068-9265

VL - 22

SP - 2526

EP - 2531

JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

IS - 8

ER -