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Low Risk of Development of a Regional Recurrence After an Unsuccessful Repeat Sentinel Lymph Node Biopsy in Patients with Ipsilateral Breast Tumor Recurrence

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

Abstract

Background

Unlike sentinel lymph node biopsy (SLNB) in the primary setting, the repeat SLNB (rSLNB) in patients with ipsilateral breast tumor recurrence (IBTR) is challenging, because it is difficult to visualize and/or harvest a sentinel lymph node in every patient. Regional treatments options and safety in terms of regional disease control after such an unsuccessful rSLNB remain unclear. This study assesses factors associated with the performance of axillary lymph node dissection (ALND) after unsuccessful rSLNB and evaluates the occurrence of regional recurrences.

Methods

Data were obtained from the Sentinel Node and Recurrent Breast Cancer (SNARB) study. In 239 patients, the rSLNB was unsuccessful, of whom 60 patients underwent ipsilateral ALND.

Results

A shorter time interval between primary treatment and IBTR, and a primary negative SLNB were significantly associated with a higher probability to be treated with ALND after unsuccessful rSLNB (P < 0.001). The 5-year regional-recurrence rate was 0.0% in the ALND group compared with 3.7% in the group treated without ALND (P = 0.113). Of the 179 patients treated without ALND, after a median follow-up of 5.1 years (range 0.3–13.2), 7 (3.9%) developed a regional recurrence as first event after unsuccessful rSLNB. None of the seven recurrences occurred in the ipsilateral axilla. Univariable analysis showed no factors associated with regional recurrence as first event after unsuccessful rSLNB (P > 0.05).

Conclusions

The present study demonstrates that the risk of regional recurrence in patients with an IBTR and an unsuccessful rSLNB is negligible, irrespective of the use of ALND. This suggests that there is no need for additional treatment of the axilla after an unsuccessful rSLNB.

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COLLABORATORS OF THE SENTINEL NODE AND RECURRENT BREAST CANCER (SNARB) STUDY GROUP

R. M. H. Roumen, MD1, E. J. T. Luiten, MD2, Prof. E. J. T. Rutgers, MD3, M. T. F. D. Vrancken-Peeters, MD3, M. Bessems, MD4, J. M. Klaase, MD5, S. Muller, MD6, A. B. Francken, MD7, T. Van Dalen, MD8, L. Jansen, MD9, S. A. Koopal, MD10, Y. L. J. Vissers, MD11, M. L. Smidt, MD12, J. W. S. Merkus, MD13, C. M. E. Contant, MD14, P. H. Veldman, MD15, E. M. H. Linthorst-Niers, MD16, J. R. van der Sijp, MD7, O. R. Guicherit, MD18, L. B. Koppert, MD19, A. M. Bosch, MD20, L. J. A. Strobbe, MD21, M. S. Schlooz-Vries, MD22, I.E. Arntz, MD23, J. A. van Essen, MD24, J. W. D. de Waard, MD25, B. C. Vrouenraets, MD26, and B. van Ooijen, MD27

1Department of Surgery, Máxima Medical Center, Veldhoven/Eindhoven, The Netherlands; 2Department of Surgery, Amphia Hospital, Breda, The Netherlands; 3Department of Surgery, The Netherlands Cancer Institute and Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; 4Department of Surgery, Jeroen Bosch Hospital, Den Bosch, The Netherlands; 5Department of Surgery, Medical Spectrum Twente, Enschede, The Netherlands; 6Department of Surgery, Zaans Medical Center, Zaandam, The Netherlands; 7Department of Surgery, Isala, Zwolle, The Netherlands; 8Department of Surgery, Diakonessen Hospital, Utrecht, The Netherlands; 9Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands; 10Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands; 11Department of Surgery, Zuyderland Medical Center, Sittard, The Netherlands; 12Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands; 13Department of Surgery, Haga Hospital, The Hague, The Netherlands; 14Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands; 15Department of Surgery, de Tjongerschans Hospital, Heerenveen, The Netherlands; 16Department of Surgery, Groene Hart Hospital, Gouda, The Netherlands; 17Department of Surgery, Medical Center Haaglanden, The Hague, The Netherlands; 18Department of Surgery, Bronovo Hospital, The Hague, The Netherlands; 19Department of Oncological Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands; 20Department of Surgery, Gelderse Vallei Hospital, Ede, The Netherlands; 21Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands; 22Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands; 23Department of Surgery, Bravis Hospital, Roosendaal, The Netherlands; 24Department of Surgery, Sint Jans Gasthuis, Weert, The Netherlands; 25Department of Surgery, Westfriesgasthuis, Hoorn, The Netherlands; 26Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands; 27Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands

Author information

Authors and Affiliations

  1. Department of Surgery, Catharina Hospital Eindhoven, 5623 EJ, Eindhoven, The Netherlands

    Ingrid G. M. Poodt MD, Coco J. E. F. Walstra MD, Guusje Vugts MD, PhD, Robert-Jan Schipper MD, PhD & Grard A. P. Nieuwenhuijzen MD, PhD

  2. Department of Surgery, Máxima Medical Center, Veldhoven/Eindhoven, The Netherlands

    Adriana J. G. Maaskant-Braat MD, PhD

  3. Department of Epidemiology, Maastricht University Medical Center, Maastricht, The Netherlands

    Adri C. Voogd PhD

  4. Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands

    Adri C. Voogd PhD

  5. GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands

    Adri C. Voogd PhD

Authors
  1. Ingrid G. M. Poodt MD
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  2. Coco J. E. F. Walstra MD
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  3. Guusje Vugts MD, PhD
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  4. Adriana J. G. Maaskant-Braat MD, PhD
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  5. Adri C. Voogd PhD
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  6. Robert-Jan Schipper MD, PhD
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  7. Grard A. P. Nieuwenhuijzen MD, PhD
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Consortia

the Sentinel Node And Recurrent Breast Cancer (SNARB) study group

  • R. M. H. Roumen
  • , E. J. T. Luiten
  • , E. J. T. Rutgers
  • , M. T. F. D. Vrancken-Peeters
  • , M. Bessems
  • , J. M. Klaase
  • , S. Muller
  • , A. B. Francken
  • , T. Van Dalen
  • , L. Jansen
  • , S. A. Koopal
  • , Y. L. J. Vissers
  • , M. L. Smidt
  • , J. W. S. Merkus
  • , C. M. E. Contant
  • , P. H. Veldman
  • , E. M. H. Linthorst-Niers
  • , J. R. van der Sijp
  • , O. R. Guicherit
  • , L. B. Koppert
  • , A. M. Bosch
  • , L. J. A. Strobbe
  • , M. S. Schlooz-Vries
  • , I. E. Arntz
  • , J. A. van Essen
  • , J. W. D. de Waard
  • , B. C. Vrouenraets
  •  & B. van Ooijen

Corresponding author

Correspondence to Ingrid G. M. Poodt MD.

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The authors declare that they have no conflict of interest.

Ethical Standard

Research done for this study complies with the current laws of The Netherlands.

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Poodt, I.G.M., Walstra, C.J.E.F., Vugts, G. et al. Low Risk of Development of a Regional Recurrence After an Unsuccessful Repeat Sentinel Lymph Node Biopsy in Patients with Ipsilateral Breast Tumor Recurrence. Ann Surg Oncol 26, 2417–2427 (2019). https://doi.org/10.1245/s10434-019-07272-4

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  • DOI: https://doi.org/10.1245/s10434-019-07272-4

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