Second Biopsy of Axillary Sentinel Lymph Node for Reappearing Breast Cancer After Previous Sentinel Lymph Node Biopsy

Division of Breast Surgery, European Institute of Oncology, Via Ripamonti, 435, 20141, Milan, Italy.
Annals of Surgical Oncology (Impact Factor: 3.93). 12/2005; 12(11):895-9. DOI: 10.1245/ASO.2005.10.018
Source: PubMed


Sentinel lymph node biopsy (SLNB) is a safe and accurate axillary staging procedure for patients with primary operable breast cancer. An increasing proportion of these patients undergo breast-conserving surgery, and 5% to 15% will develop local relapses that necessitate reoperation. Although a previous SLNB is often considered a contraindication for a subsequent SLNB, few data support this concern.
Between January 2000 and June 2004, 79 patients who were previously treated at our institution with breast-conserving surgery and who had a negative SLNB for early breast cancer developed, during follow-up, local recurrence that was amenable to reoperation. Eighteen of these patients were offered a second SLNB because of a clinically negative axillary status an average of 26.1 months after the primary event.
In all 18 patients (7 with ductal carcinoma-in-situ and 11 with invasive recurrences), preoperative lymphoscintigraphy showed an axillary sentinel lymph node, with a preoperative identification rate of 100%, and 1 or more SLNs (an average of 1.3 per patient) were surgically removed. Sentinel lymph node metastases were detected in two patients with invasive recurrence, and a complete axillary dissection followed. At a median follow up of 12.7 months, no axillary recurrences have occurred in patients who did not undergo axillary dissection.
Second SLNB after previous SLNB is technically feasible and likely effective in selected breast cancer patients. A larger population and longer follow-up are necessary to confirm these preliminary data.

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Available from: Giuseppe Trifiro, Jul 13, 2015
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    • "There are other sub-classifications of breast cancer as well, such as the one that classifies breast cancers into luminal A, luminal B, basal and HER2 enriched [11]. Irrespective of the underlying breast cancer subtype, the presence of axillary lymph node metastases is associated with considerable poor disease-free as well as overall survival [12,13]. Lymph node metastases remain a very important prognostic variable, and identification of lymph node metastases can potentially help in early intervention by reducing the chances of breast cancer progression. "
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    ABSTRACT: Background In patients with recurrent or second primary ipsilateral breast cancer, axillary staging is the key factor in locoregional control and a strong prognostic characteristic. The efficient evaluation of lymphatic drainage of re-sentinel lymph node biopsies (re-SLNBs) has remained a challenge in the management of ipsilateral primary or recurrent breast cancer patients who are clinically lymph node negative. This study explores whether a SLNB for patients with primary or recurrent breast cancer is possible after previous axillary surgery. It evaluates potential reasons for mapping failure that might be associated with patients in this group. Methods Between March 2006 and November 2013, 458 patients were subjected to a breast SLNB. A lymphoscintigraphy procedure was performed on 330 patients for sentinel lymph node (SLN) mapping on the day of surgery. Seven patients with either a second primary cancer in the same breast or recurrent breast cancer were described. Two of these seven patients had axillary lymph node dissection (ALND) during previous treatments and five had SLNB. A dual mapping method was used for all patients. Preoperative lymphoscintigraphy was performed four hours before surgery. Results SLNs were successfully remapped in six of seven (85.7%) patients, of whom five (71.43%) had previously undergone SLNB and two (28.57%) previous ALND. Localizations of SLNs were ipsilateral axillary in three patients, ipsilateral internal mammary in one patient, and contralateral axillary in two patients. An altered distribution of lymph nodes was discovered in both patients with previous ALND. In one of the two patients, metastases were found in an aberrant lymph drainage basin at the location of a non-ipsilateral axillary node (contralateral axillary SLN). The second previously ALND patient had an internal mammary SLN. In one patient, mapping was unsuccessful and the SLN was not identified. Conclusions Altered lymphatic drainage incidence increases following breast-conserving surgery for an initial breast cancer, and the location of SLNs becomes unpredictable at the time of a second primary or recurrent ipsilateral breast cancer. This leads to the necessity of using a radionuclide (lymphoscintigraphy) for a successful re-mapping procedure. A re-SLNB is precise and beneficial even though there are few patients. A lymphoscintigraphy can identify SLNs at their new unpredicted location.
    Full-text · Article · Jul 2014 · World Journal of Surgical Oncology
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    • "In fact, a novel SLN has been documented in a case of small breast recurrence after breast conserving surgery (BCS) and complete axillary dissection (CAD) (the new SLN was in the contralateral axilla) [18], after partial axillary dissection (PAD) (the new SLN was in the ipsilateral axilla) [19], and after previous SLNB (again, the new SLN was in the ipsilateral axilla) [20]. These considerations, introducing a new dynamic concept of SLN (not " one SLN for ever " but " always a new SLN " ), have convinced authors to propose and successfully perform lymphoscintigraphy and SLNB after BCS and previous CAD [18], PAD [19] and SLNB [20]. "

    Preview · Article · Jan 2010 · Journal of Cancer Therapy
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    • "Port et al., reported that repeat SLNB failed in 25% of patients compared with less than 5% among women who had not previous axillary surgery [40]. On the other hand, a study from the Memorial Sloan Kettering Cancer Centre showed that re-operative SLNB after previous axillary lymph node dissection (ALND) is feasible in selected breast cancer patients and is more likely to succeed when fewer that 10 nodes were removed during the earlier procedure [41]. In this study, the identification rate for the SLNB in patients with primary breast carcinoma was between 94% and 97% with a false negative rate of 4–5%. "
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    ABSTRACT: One of the most exciting and talked about new surgical techniques in breast cancer surgery is the sentinel lymph node biopsy. It is an alternative procedure to standard axillary lymph node dissection, which makes possible less invasive surgery and side effects for patients with early breast cancer that wouldn't benefit further from axillary lymph node clearance. Sentinel lymph node biopsy helps to accurately evaluate the status of the axilla and the extent of disease, but also determines appropriate adjuvant treatment and long-term follow-up. However, like all surgical procedures, the sentinel lymph node biopsy is not appropriate for each and every patient. In this article we review the absolute and relative contraindications of the procedure in respect to clinically positive axilla, neoadjuvant therapy, tumor size, multicentric and multifocal disease, in situ carcinoma, pregnancy, age, body-mass index, allergies to dye and/or radio colloid and prior breast and/or axillary surgery. Certain conditions involving host factors and tumor biologic characteristics may have a negative impact on the success rate and accuracy of the procedure. The overall fraction of patients unsuitable or with multiple risk factors that may compromise the success of the sentinel lymph node biopsy, is very small. Nevertheless, these patients need to be successfully identified, appropriately advised and cautioned, and so do the surgeons that perform the procedure. When performed by an experienced multi-disciplinary team, the SLNB is a highly effective and accurate alternative to standard level I and II axillary clearance in the vast majority of patients with early breast cancer.
    Full-text · Article · Feb 2007 · World Journal of Surgical Oncology
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