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Improving the Success Rate of Repeat Sentinel Node Biopsy in Recurrent Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Repeat sentinel node biopsy (SNB) is an alternative to axillary lymph node dissection (ALND) for axillary staging in recurrent breast cancer. This study was conducted to determine factors associated with technical success of repeat SNB.

Methods

A total of 536 patients with locally recurrent nonmetastatic breast cancer underwent lymphatic mapping (LM) and repeat SNB in 29 Dutch hospitals.

Results

A total of 179 patients previously underwent breast-conserving surgery (BCS) with SNB, 262 patients BCS with ALND and 61 patients mastectomy, 35 with SNB and 26 with ALND. Another 34 patients underwent breast surgery without axillary interventions. A repeat sentinel node (SN) was identified in 333 patients (62.1 %) and was successfully removed in 235 (53.5 %). The overall repeat SN identification rate was 62.1 %, varying from 35 to 100 % in the participating hospitals. Previous radiotherapy of the breast [odds ratio (OR) 0.16; 95 % confidence interval (CI) 0.03–0.84], subareolar tracer injection (OR 0.34; 95 % CI 0.16–0.73), and a 2-day LM protocol (OR 0.57; 95 % CI 0.33–0.97) after previous BCS were independently associated with failure of SN identification. Injection of a larger amount of tracer (>180 MBq) led to a higher identification rate (OR 4.40; 95 % CI 1.45–13.32).

Conclusions

Repeat SNB is a technically feasible procedure for axillary staging in recurrent breast cancer patients. Previous radiotherapy appears to be associated with failure of SN identification. Injection with a larger amount of tracer (>180 MBq) leads to a higher identification rate; subareolar injection and a 2-day LM protocol after previous BCS appear to be less adequate.

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Acknowledgment

The authors thank the following clinicians for patient recruitment and providing the study data: Mw. Dr. M. Bessems, Mw. Dr. M. F. Ernst, Dr. J. M. Klaase, Dr. F. C. Den Boer, Mw. Drs. S. Muller, Dr. J. E. De Vries, Mw. Dr. A. B. Francken, Mw. J. P. J. Burgmans, Dr. T. Van Dalen, Mw. Dr. L. Jansen, Mw. Drs. C. I.E. Scheeren, Dr. S. A. Koopal, Dr. F. W. C. van der Ent, Mw. Dr. Y. L. J. Vissers, Mw. Dr. M. L. Smidt, Dr. J. W. S. Merkus, Mw. Dr. C. M. E. Contant, Dr. P. H. J. M. Veldman, Dr. R. F. Schmitz, Mw. Dr. E. Linthorst-Niers, Dr. J. R. M. van der Sijp, Dr. O. R. Guicherit, Mw. Dr. M. B. E. Menke-Pluymers, Mw. Dr. L. B. Koppert, Mw. Dr. A. M. Bosch, Dr. L. J. A. Strobbe, Prof. Dr. H. De Wilt, Mw. Drs. M. S. Schlooz-Vries, Mw. Dr. P. G. Boelens, Dr. H. W. P. M. Kemperman, Dr. J. A. van Essen, Dr. J. W. D. de Waard, Dr. B. C. Vrouenraets, and Dr. B. van Ooijen. The authors thank the Dutch Breast Cancer Trialists’ Group (BOOG) for their support in promoting, coordinating, and facilitating the SNARB study. This study was supported by a Grant from the Dutch Cancer Society—KWF (Grant 2009-4466) for data registration and management.

Disclosure

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands

    G. Vugts MD, A. J. G. Maaskant-Braat MD, PhD, Y. E. A. van Riet MD, H. J. T. Rutten MD, PhD & G. A. P. Nieuwenhuijzen MD, PhD

  2. Department of Epidemiology, Maastricht University, Maastricht, The Netherlands

    A. C. Voogd PhD

  3. Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands

    A. C. Voogd PhD

  4. GROW—School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands

    A. C. Voogd PhD & R. M. H. Roumen MD, PhD

  5. Department of Surgery, Maxima Medical Centre, Veldhoven, The Netherlands

    R. M. H. Roumen MD, PhD

  6. Department of Surgery, Amphia Hospital, Breda, The Netherlands

    E. J. T. Luiten MD, PhD

  7. Department of Surgery, The Netherlands Cancer Institute—Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

    E. J. Th. Rutgers MD, PhD

  8. Department of Nuclear Medicine, Catharina Hospital, Eindhoven, The Netherlands

    D. Wyndaele MD

Authors
  1. G. Vugts MD
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  2. A. J. G. Maaskant-Braat MD, PhD
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  3. A. C. Voogd PhD
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  4. Y. E. A. van Riet MD
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  5. R. M. H. Roumen MD, PhD
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  6. E. J. T. Luiten MD, PhD
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  7. E. J. Th. Rutgers MD, PhD
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  8. D. Wyndaele MD
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  9. H. J. T. Rutten MD, PhD
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  10. G. A. P. Nieuwenhuijzen MD, PhD
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Corresponding author

Correspondence to G. Vugts MD.

Additional information

On behalf of the Sentinel Node and Recurrent Breast Cancer (SNARB) study group.

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Vugts, G., Maaskant-Braat, A.J.G., Voogd, A.C. et al. Improving the Success Rate of Repeat Sentinel Node Biopsy in Recurrent Breast Cancer. Ann Surg Oncol 22 (Suppl 3), 529–535 (2015). https://doi.org/10.1245/s10434-015-4787-6

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  • DOI: https://doi.org/10.1245/s10434-015-4787-6

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