Annals of Surgical Oncology

, Volume 12, Issue 1, pp 34–40 | Cite as

Axillary Recurrence After Sentinel Node Biopsy

  • Jacqueline Sara Jeruss
  • David J. Winchester
  • Stephen F. Sener
  • Erika M. Brinkmann
  • Malcolm M. Bilimoria
  • Ermilo BarreraJr.
  • Eihab Alwawi
  • Angel Nickolov
  • G. M. Schermerhorn
  • David J. Winchester
Original Article



Sentinel node biopsy (SNB) has evolved as the standard of care in the surgical staging of breast cancer. This technique is accurate for surgical staging of axillary nodal disease. We hypothesized that axillary recurrence after SNB is rare and that SNB may provide regional control in patients with microscopic nodal involvement.


With institutional review board approval, SNB was performed with peritumoral injection of 99mTc-labeled sulfur colloid. From 1996 to 2003, 1167 patients were entered into a prospective cancer database after surgical therapy; 916 patients consented to long-term follow-up. Fifty-two patients (5.7%) did not map successfully and were excluded, leading to a study population of 864 patients. The median follow-up was 27.4 months (range, 1–98 months).


The median number of sentinel nodes harvested was 2, and 633 (73%) patients had negative sentinel nodes. Thirty (4.7%) of those sentinel node–negative patients underwent completion axillary dissection, whereas 592 (94%) patients were followed up with observation. A total of 231 (27%) had positive sentinel nodes: 158 (68%) of these patients underwent completion axillary dissection, and 73 (32%) were managed with observation alone. Two (.32%) patients who were sentinel node negative had an axillary recurrence; one of these patients had undergone completion axillary dissection. No patient in the observed sentinel node–positive group had an axillary recurrence (odds ratio, .37; P = .725).


On the basis of a median follow-up of 27.4 months, axillary recurrence after SNB is extraordinarily rare regardless of nodal involvement, thus indicating that this technique provides an accurate measure of axillary disease and may impart regional control for patients with node-positive disease.


Sentinel node biopsy Axillary recurrence Breast cancer Surgical staging 



We thank Mary Turk and Dr. Stacey C. Tobin for their assistance in preparing this manuscript.


  1. 1.
    Fisher, B, Montague, E, Redmond, C,  et al. 1980Findings from NSABP Protocol No. B-04. Comparison of radical mastectomy with alternative treatments for primary breast cancerCancer46113PubMedGoogle Scholar
  2. 2.
    Fisher, B, Bauer, M, Margolese, R,  et al. 1985Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancerN Engl J Med31266573PubMedCrossRefGoogle Scholar
  3. 3.
    Veronesi, U, Banfi, A, De Vecchio, M, Clemente, C, Greco, M 1986Comparison of Halsted mastectomy with quadrantectomy, axillary dissection, and radiotherapy in early breast cancer: long-term resultsEur J Cancer Clin Oncol2210859PubMedGoogle Scholar
  4. 4.
    Moore, M, Kinne, D 1997Axillary lymphadenectomy: a diagnostic and therapeutic procedureJ Surg Oncol6626PubMedGoogle Scholar
  5. 5.
    Moore, M, Kinne, D 1996Is axillary lymph node dissection necessary in the routine management of breast cancer? YesImportant Adv Oncol2924550Google Scholar
  6. 6.
    Blanchard, DK, Donohue, J, Reynolds, C,  et al. 2003Relapse and morbidity in patients undergoing sentinel lymph node biopsy alone or with axillary dissection for breast cancerArch Surg1384828CrossRefPubMedGoogle Scholar
  7. 7.
    Reitsamer, R, Peintinger, F, Prokop, E,  et al. 2003Sentinel lymph node biopsy alone without axillary lymph node dissection–follow up of sentinel lymph node-negative breast cancer patientsEur J Surg Oncol292213CrossRefPubMedGoogle Scholar
  8. 8.
    Sener, SF, Winchester, DJ, Martz, CH,  et al. 2001Lymphedema after sentinel lymphadenectomy for breast carcinomaCancer9274852CrossRefPubMedGoogle Scholar
  9. 9.
    Krag, D, Weaver, D, Ashikaga, T,  et al. 1998The sentinel node in breast cancerN Engl J Med3399416CrossRefPubMedGoogle Scholar
  10. 10.
    Alex, JC, Krag, DN 1993Gamma-probe guided localization of lymph nodesSurg Oncol213743CrossRefPubMedGoogle Scholar
  11. 11.
    Giuliano, AE, Kirgan, DM, Guenther, JM,  et al. 1994Lymphatic mapping and sentinel lymphadenectomy for breast cancerAnn Surg220391401PubMedGoogle Scholar
  12. 12.
    Winchester, DJ, Sener, SF, Winchester, DP,  et al. 1999Sentinel lymphadenectomy for breast cancer: experience with 180 consecutive patients: efficacy of filtered technetium 99m sulphur colloid with overnight migration timeJ Am Coll Surg188597603PubMedGoogle Scholar
  13. 13.
    Schawartz, GF, Giuliano, AE, Veronesi, U 2002The Consensus Conference Committee: proceedings of the consensus conference of the role of sentinel lymph node biopsy in carcinoma of the breast, April 19–22, 2001, Philadelphia, PennsylvaniaCancer94254251CrossRefPubMedGoogle Scholar
  14. 14.
    Widt-Levert, LM, Tjan-Heijnen, VCG, Bult, P,  et al. 2003Stage migration in breast cancer: surgical decisions concerning isolated tumor cells and micro-metastases in the sentinel lymph nodeEur J Surg Oncol2921620PubMedGoogle Scholar
  15. 15.
    Giuliano, AE, Haigh, PI, Brennan, MB,  et al. 2000Prospective observational study of sentinel lymphadenectomy without further axillary dissection in patients with sentinel node-negative breast cancerJ Clin Oncol1825539PubMedGoogle Scholar
  16. 16.
    Chung, MA, Steinhoff, MD, Cady, B 2002Clinical axillary recurrence in breast cancer patients after a negative sentinel node biopsyAm J Surg1843104CrossRefPubMedGoogle Scholar
  17. 17.
    Badgwell, BD, Povoski, SP, Abdessalam, SF,  et al. 2003Patterns of recurrence after sentinel lymph node biopsy for breast cancerAnn Surg Oncol1037680PubMedGoogle Scholar
  18. 18.
    Wilke, LG, Giuliano, A 2003Sentinel lymph node biopsy in patients with early-stage breast cancer: status of the National Clinical TrialsSurg Clin North Am8390110PubMedGoogle Scholar
  19. 19.
    Fant, JS, Grant, MD, Knox, SM,  et al. 2003Preliminary outcome analysis in patients with breast cancer and a positive lymph node who declined axillary dissectionAnn Surg Oncol1012630PubMedGoogle Scholar
  20. 20.
    Guenther, JM, Hansen, NM, DiFronzo, A,  et al. 2003Axillary dissection is not required for all patients with breast cancer and positive sentinel lymph nodesArch Surg138526PubMedCrossRefGoogle Scholar
  21. 21.
    Veronesi, U, Rilke, F, Luini, A,  et al. 1987Distribution of axillary node metastases by level of invasion. An analysis of 539 casesCancer596827PubMedGoogle Scholar
  22. 22.
    Wright, FC, Walker, J, Law, L,  et al. 2003Outcomes after localized axillary node recurrence in breast cancerAnn Surg Oncol1010548PubMedGoogle Scholar
  23. 23.
    Clemons, M, Danson, S, Hamilton, T, Gross, P 2001Locoregionally recurrent breast cancer: incidence, risk factors, and survivalCancer Treat Rev276782PubMedGoogle Scholar
  24. 24.
    Noguchi, M 2003Is it necessary to perform prospective randomized studies before sentinel node biopsy can replace routine axillary dissection?Breast Cancer1017987CrossRefPubMedGoogle Scholar
  25. 25.
    Giuliano, AE, Dale, PS, Turner, RR, Morton, DL, Evans, SW, Krasne, DL 1995Improved axillary staging of breast cancer with sentinel lymphadenectomyAnn Surg2223949PubMedGoogle Scholar
  26. 26.
    Voogd, AC, Coebergh, JW, Repelaer van Dreil, OJ,  et al. 2000The risk of breast cancer metastases in breast cancer patients with clinically negative lymph nodes: a population-based analysisBreast Cancer Res Treat62639PubMedGoogle Scholar
  27. 27.
    Abdessalam, SF, Zervos, EE, Prasad, M,  et al. 2001Predictors of positive axillary lymph nodes after sentinel lymph node biopsy in breast cancerAm J Surg18231620PubMedGoogle Scholar
  28. 28.
    Ahlgren, J, Holmberg, L, Bergh, J, Liljegren, G 2002Five-node biopsy of the axilla: an alternative to axillary dissection of levels I-II in operable breast cancerEur J Surg Oncol2897102PubMedGoogle Scholar
  29. 29.
    Mathiesen, O, Carl, J, Bonderup, O, Panduro, J 1990Axillary sampling and the risk of erroneous staging of breast cancer. An analysis of 960 consecutive patientsActa Oncol297215PubMedGoogle Scholar
  30. 30.
    Fisher, B, Brown, A, Mamounas, E,  et al. 1997Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18J Clin Oncol15248393PubMedGoogle Scholar
  31. 31.
    Marschall, J, Nechala, P, Colquhoun, P,  et al. 2003Reassessing the role of axillary lymph-node dissection in patients with early-stage breast cancerCan J Surg462859PubMedGoogle Scholar
  32. 32.
    Janssen, CMM, Smidt, ML, Bruggink, ED, Strobbe, LJ 2004Axillary recurrences after negative sentinel node biopsy for breast cancer: incidence and clinical significanceAnn Surg Oncol11S76Google Scholar
  33. 33.
    Yen, TWF, Mann, GN, Lawton, TJ,  et al. 2003An axillary recurrence of breast cancer following a negative sentinel lymph node biopsyBreast J92346PubMedGoogle Scholar
  34. 34.
    Salmon, RJ, Bouillet, TH, Lewis, JS, Clough, KB 2002Recurrence in the axilla after sentinel lymph node biopsy for breast cancerEur J Surg Oncol28199PubMedGoogle Scholar
  35. 35.
    Schrenk, P, Hatzl-Griesenhodfer, M, Shamiyeh, A, Waynad, W 2001Follow-up of sentinel node negative breast cancer patients without axillary lymph node dissectionJ Surg Oncol7716570PubMedGoogle Scholar
  36. 36.
    Roumen, RM, Kuijt, GP, Liem, IH, Beek, MW 2001Treatment of 100 patients with sentinel node-negative breast cancer without further axillary dissectionBr J Surg88163943CrossRefPubMedGoogle Scholar

Copyright information

© The Society of Surgical Oncology, Inc. 2004

Authors and Affiliations

  • Jacqueline Sara Jeruss
    • 1
  • David J. Winchester
    • 1
    • 2
  • Stephen F. Sener
    • 1
    • 2
  • Erika M. Brinkmann
    • 1
    • 2
  • Malcolm M. Bilimoria
    • 1
    • 2
  • Ermilo BarreraJr.
    • 1
    • 2
  • Eihab Alwawi
    • 2
  • Angel Nickolov
    • 2
  • G. M. Schermerhorn
    • 2
  • David J. Winchester
    • 1
    • 2
  1. 1.Feinberg School of Medicine, Northwestern UniversityChicago
  2. 2.Evanston Northwestern HealthcareEvanston

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