Breast Cancer Research and Treatment

, Volume 138, Issue 1, pp 13–20 | Cite as

Repeat sentinel node biopsy in patients with locally recurrent breast cancer: a systematic review and meta-analysis of the literature

  • Adriana J. G. Maaskant-BraatEmail author
  • Adri C. Voogd
  • Rudi M. H. Roumen
  • Grard A. P. Nieuwenhuijzen


Axillary staging in patients with locally recurrent breast cancer is important for obtaining locoregional control and predicting prognosis. The aim of the present study is to determine technical feasibility, validity, aberrant drainage patterns and clinical consequences of performing repeat sentinel node biopsy (SNB) in these patients. We performed a systematic review and meta-analysis of the literature and included all studies on repeat SNB in locally recurrent breast cancer. A total of 692 patients were described, 301 after a previous SNB, 361 after a previous axillary lymph node dissection (ALND), and 30 with no previous axillary surgery. Sentinel node identification was successful in 452 of the 692 patients (65.3 %), which was significantly higher in patients who had undergone previous SNB compared to previous ALND (81.0 vs. 52.2 %) (P < 0.0001). In 175 of 405 patients with successful lymphatic mapping aberrant drainage pathways were visualized (43.2 %), which were seen more frequently after previous ALND than after previous SNB (69.2 vs. 17.4 %) (P < 0.0001). In 19.2 % of the patients the sentinel node was tumor positive and 27.5 % of these metastases were found in aberrant lymph drainage basins. Overall, 213 patients could be spared an ALND and in 17.9 % of the patients the information derived from the repeat SNB led to a change in adjuvant radiotherapy or systemic treatment plans. The procedure had a false-negative rate of 0.2 %. Repeat SNB is technically feasible and accurate. Next to sparing patients an unnecessary ALND, the information can lead to a change in adjuvant treatment strategy.


Repeat sentinel node biopsy Recurrent breast cancer Sentinel (lymph) node biopsy 


Conflict of interest

The authors declare no conflicts of interest.

Supplementary material

10549_2013_2409_MOESM1_ESM.docx (76 kb)
Supplementary material 1 (DOCX 76 kb)


  1. 1.
    Nationaal Borstkanker Overleg Nederland (NABON) (2008) Richtlijn behandeling van het mammacarcinoom. Accessed 2 March 2012
  2. 2.
    Kim T, Giuliano AE, Lyman GH (2006) Lymphatic mapping and sentinel lymph node biopsy in early-staged breast carcinoma, a metaanalysis. Cancer 106:4–16PubMedCrossRefGoogle Scholar
  3. 3.
    Naik AM, Fey J, Gemignani M et al (2004) The risk of axillary relapse after sentinel lymph node biopsy for breast cancer is comparable with that of axillary lymph node dissection, a follow-up study of 4008 procedures. Ann Surg 240:462–471PubMedCrossRefGoogle Scholar
  4. 4.
    Veronesi U, Paganelli G, Viale G et al (2006) Sentinel-lymph-node biopsy as a staging procedure in breast cancer: update of a randomised controlled study. Lancet Oncol 7:983–990PubMedCrossRefGoogle Scholar
  5. 5.
    van der Ploeg IM, Nieweg OE, van Rijk MC et al (2008) Axillary recurrence after a tumour-negative sentinel node biopsy in breast cancer patients: a systematic review and meta-analysis of the literature. Eur J Surg Oncol 34:1277–1284PubMedCrossRefGoogle Scholar
  6. 6.
    Veronesi U, Cascinelli N, Mariani L et al (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347:1227–1232PubMedCrossRefGoogle Scholar
  7. 7.
    Voogd AC, Nielsen M, Peterse JL et al (2001) Differences in risk factors for local and distant recurrence after breast-conserving therapy or mastectomy for stage I and II breast cancer: pooled results of two large European randomized trials. J Clin Oncol 15:1688–1697Google Scholar
  8. 8.
    Overgaard M, Hansen PS, Overgaard J et al (1997) Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. N Engl J Med 337:949–955PubMedCrossRefGoogle Scholar
  9. 9.
    Orr RK (1999) The impact of prophylactic axillary node dissection on breast cancer survival—a Bayesian meta-analysis. Ann Surg Oncol 6:109–116PubMedCrossRefGoogle Scholar
  10. 10.
    Schijven MP, Vingerhoets AJJM, Rutten HJT, Nieuwenhuijzen GAP, Roumen RMH, van Bussel ME, Voogd AC (2003) Comparison of morbidity between axillary lymph node dissection and sentinel node biopsy. Eur J Surg Oncol 29:341–350PubMedCrossRefGoogle Scholar
  11. 11.
    Port ER, Fey J, Gemignani ML et al (2002) Reoperative sentinel lymph node biopsy: a new option for patients with primary or locally recurrent breast carcinoma. J Am Coll Surg 195:167–172PubMedCrossRefGoogle Scholar
  12. 12.
    Intra M, Trifirò G, Viale G et al (2005) Second biopsy of axillary sentinel lymph node for reappearing breast cancer after previous sentinel lymph node biopsy. Ann Surg Oncol 12:895–899PubMedCrossRefGoogle Scholar
  13. 13.
    Lim I, Shim J, Goyenechea M, Kim CK, Krynyckyi BR (2004) Drainage across midline to sentinel nodes in the contralateral axilla in breast cancer. Clin Nucl Med 29:346–347PubMedCrossRefGoogle Scholar
  14. 14.
    Sood A, Youssef IM, Heiba SI, El-Zeftawy H, Axelrod D, Seigel B, Mills C et al (2004) Alternative lymphatic pathway after previous axillary node dissection in recurrent/primary breast cancer. Clin Nucl Med 29:698–702PubMedCrossRefGoogle Scholar
  15. 15.
    Agarwal A, Heron DE, Sumkin J, Falk J (2005) Contralateral uptake and metastases in sentinel lymph node mapping for recurrent breast cancer. J Surg Oncol 92:4–8PubMedCrossRefGoogle Scholar
  16. 16.
    Dinan D, Nagle CE, Pettinga J (2005) Lymphatic mapping and sentinel node biopsy in women with an ipsilateral second breast carcinoma and a history of breast and axillary surgery. Am J Surg 190:614–617PubMedCrossRefGoogle Scholar
  17. 17.
    Tada K, Nishimura S, Miyagi Y et al (2005) The effect of an old surgical scar on sentinel node mapping in patients with breast cancer: a report of five cases. Eur J Surg Oncol 31:840–844PubMedCrossRefGoogle Scholar
  18. 18.
    Boughey JC, Ross MI, Babiera GV et al (2006) Sentinel lymph node surgery in locally recurrent breast cancer. Clin Breast Cancer 7:248–253PubMedCrossRefGoogle Scholar
  19. 19.
    Jackson BM, Kim S, Davidson R, Schuchter L, Acs G, Czerniecki BJ (2006) Repeat operative sentinel lymph node biopsy. Clin Breast Cancer 6:530–532PubMedCrossRefGoogle Scholar
  20. 20.
    Newman EA, Cimmino VM, Sabel MS, Diehl KM, Frey KA, Chang AE, Newman LA (2006) Lymphatic mapping and sentinel lymph node biopsy for patients with local recurrence after breast-conservation therapy. Ann Surg Oncol 13:52–57PubMedCrossRefGoogle Scholar
  21. 21.
    Roumen RMH, Kuijt GP, Liem IH (2006) Lymphatic mapping and sentinel node harvesting in patients with recurrent breast cancer. Eur J Surg Oncol 32:1076–1081PubMedCrossRefGoogle Scholar
  22. 22.
    Taback B, Nguyen P, Hansen N, Edwards GK, Conway K, Giuliano AE (2006) Sentinel lymph node biopsy for local recurrence of breast cancer after breast-conserving therapy. Ann Surg Oncol 13:1099–1104PubMedCrossRefGoogle Scholar
  23. 23.
    Barone JL, Feldman SM, Estabrook A, Tartter PI, Rosenbaum Smith SM, Boolbol SK (2007) Reoperative sentinel lymph node biopsy in patients with locally recurrent breast cancer. Am J Surg 194:491–493PubMedCrossRefGoogle Scholar
  24. 24.
    Intra M, Trifirò G, Galimberti V, Gentilini O, Rotmensz N, Veronesi P (2007) Second axillary sentinel node biopsy for ipsilateral breast tumour recurrence. Br J Surg 94:1216–1219PubMedCrossRefGoogle Scholar
  25. 25.
    Port ER, Garcia-Etienne CA, Park J, Fey J, Borgen PI, Cody HS 3rd (2007) Reoperative sentinel lymph node biopsy: a new frontier in the management of ipsilateral breast tumor recurrence. Ann Surg Oncol 14:2209–2214PubMedCrossRefGoogle Scholar
  26. 26.
    Axelsson CK, Jonsson PE (2008) Sentinel lymph node biopsy in operations for recurrent breast cancer. Eur J Surg Oncol 34:626–630PubMedCrossRefGoogle Scholar
  27. 27.
    Cox CE, Furman BT, Kiluk JV et al (2008) Use of reoperative sentinel lymph node biopsy in breast cancer patients. J Am Coll Surg 207:57–61PubMedCrossRefGoogle Scholar
  28. 28.
    Karam A, Stempel M, Cody HS, Port ER (2008) Reoperative sentinel lymph node biopsy after previous mastectomy. J Am Coll Surg 207:543–548PubMedCrossRefGoogle Scholar
  29. 29.
    Koizumi M, Koyama M, Tada K et al (2008) The feasibility of sentinel node biopsy in the previously treated breast. Eur J Surg Oncol 34:365–368PubMedCrossRefGoogle Scholar
  30. 30.
    Schrenk P, Tausch C, Wayand W (2008) Lymphatic mapping in patients with primary or recurrent breast cancer following previous axillary surgery. Eur J Surg Oncol 34:851–856PubMedCrossRefGoogle Scholar
  31. 31.
    Tasevski R, Gogos AJ, Mann GB (2009) Reoperative sentinel lymph node biopsy in ipsilateral breast cancer relapse. Breast 18:322–326PubMedCrossRefGoogle Scholar
  32. 32.
    Van der Ploeg IMC, Oldenburg HSA, Rutgers EJT et al (2010) Lymphatic drainage patterns from the treated breast. Ann Surg Oncol 17:1069–1075PubMedCrossRefGoogle Scholar
  33. 33.
    Vicente DA, Henry LR, Hahm G, Soballe PW, Smart D (2010) Axillary sentinel lymph node biopsy after mastectomy: a case report. World J Surg Oncol 8:59PubMedCrossRefGoogle Scholar
  34. 34.
    Yamashita T, Fujita T, Hayahi H et al (2011) Detection of parasternal metastatic lymph nodes by sentinel lymph node methods in a patient with recurrence in the conserved breast. Breast Cancer. doi: 10.1007/s12282-010-0248-z
  35. 35.
    Hattori M, Nishimura S, Tada K et al (2011) Reoperative sentinel lymph node biopsy for ipsilateral breast tumor recurrence after previous axillary lymph node dissection: report of a case. Surg Today 41:247–250PubMedCrossRefGoogle Scholar
  36. 36.
    Kaur P, Kiluk JV, Meade T et al (2011) Sentinel lymph node biopsy in patients with previous ipsilateral complete axillary lymph node dissection. Ann Surg Oncol 18:727–732PubMedCrossRefGoogle Scholar
  37. 37.
    Maaskant-Braat A, Roumen R, Pijpers H, Nieuwenhuijzen GAP (2011) Sentinel node and recurrent breast cancer (SNARB): results of an interim-analysis. Ann Surg Oncol 18:1–144. doi: 10.1245/s10434-011-1552-3 Google Scholar
  38. 38.
    Povoski SP, Olsen JO, Young DC, Clarke J, Burak WE, Walker MJ, Carson WE et al (2006) Prospective randomized clinical trial comparing intradermal, intraparenchymal, and subareolar injection routes for sentinel lymph node mapping and biopsy in breast cancer. Ann Surg Oncol 13:1412–1421PubMedCrossRefGoogle Scholar
  39. 39.
    Grant RN, Tabah EJ, Adair FE (1953) The surgical significance of the subareolar lymph plexus in cancer of the breast. Surgery 33:71–78PubMedGoogle Scholar
  40. 40.
    Suami H, Pan W, Taylor GI (2009) Historical review of breast lymphatic studies. Clin Anat 22:531–536PubMedCrossRefGoogle Scholar
  41. 41.
    Suami H, Pan W, Mann GB, Taylor GI (2007) The lymphatic anatomy of the breast and its implications for sentinel lymph node biopsy. Ann Surg Oncol 15:863–871PubMedCrossRefGoogle Scholar
  42. 42.
    Morcos B, Jaradat I, El-Ghanem M (2011) Characteristics of and therapeutic options for contralateral axillary lymph node metastasis in breast cancer. Eur J Surg Oncol 37:418–421PubMedCrossRefGoogle Scholar
  43. 43.
    Overgaard M, Jensen MB, Overgaard J et al (1999) Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomised trial. Lancet 353:1641–1648PubMedCrossRefGoogle Scholar
  44. 44.
    Borner M, Bacchi M, Goldhirsch A et al (1994) First isolated locoregional recurrence following mastectomy for breast cancer: results of a phase. III. Multicenter study comparing systemic treatment with observation after excision and radiation. Swiss Group for Clinical Cancer Research. J Clin Oncol 12:2071–2077PubMedGoogle Scholar
  45. 45.
    Haylock BJ, Coppin CM, Jackson J, Basco VE, Wilson KS (2000) Locoregional first recurrence after mastectomy: prospective cohort studies with and without immediate chemotherapy. Int J Radiat Oncol Biol Phys 46:355–362PubMedCrossRefGoogle Scholar
  46. 46.
    Rauschecker H, Clarke M, Gatzemeier W, Recht A (2001) Systemic therapy for treating locoregional recurrence in women with breast cancer. Cochrane Database Syst Rev 4:CD002195PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Adriana J. G. Maaskant-Braat
    • 1
    Email author
  • Adri C. Voogd
    • 2
    • 3
  • Rudi M. H. Roumen
    • 4
  • Grard A. P. Nieuwenhuijzen
    • 1
  1. 1.Department of SurgeryCatharina HospitalEindhovenThe Netherlands
  2. 2.Department of Epidemiology, Faculty of Health Medicine and Life Sciences, Research Institute Growth and Development (GROW)Maastricht UniversityMaastrichtThe Netherlands
  3. 3.Eindhoven Cancer RegistryComprehensive Cancer Center SouthEindhovenThe Netherlands
  4. 4.Department of SurgeryMáxima Medical CenterVeldhoven/EindhovenThe Netherlands

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