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Annals of Surgical Oncology

, Volume 20, Issue 2, pp 620–626 | Cite as

Sentinel Node and Recurrent Breast Cancer (SNARB): Results of a Nationwide Registration Study

  • Adriana J. G. Maaskant-BraatEmail author
  • Rudi M. H. Roumen
  • Adri C. Voogd
  • Rik Pijpers
  • Ernest J. T. Luiten
  • Emiel J. T. Rutgers
  • Grard A. P. Nieuwenhuijzen
Breast Oncology

Abstract

Background

Knowledge of regional lymph node involvement is important in patients with recurrent breast cancer for obtaining better locoregional control and predicting prognosis. To determine technical feasibility, validity, aberrant drainage rates, and clinical consequences of performing repeat sentinel node biopsy (SNB) in patients with locally recurrent breast cancer we conducted the “Sentinel Node and Recurrent Breast Cancer (SNARB)” study.

Methods

A total of 150 patients with locally recurrent breast cancer underwent lymphatic mapping and SNB. In case of an intact axillary lymph node basin, ipsilateral axillary lymph node dissection (ALND) was performed subsequently.

Results

A total of 41 patients previously underwent breast conserving therapy (BCT) with SNB, 82 patients BCT with ALND, and 21 patients a mastectomy, of which 9 with SNB and 12 with ALND. In 95 patients (63.3 %) a sentinel node was identified and in 78 patients (52 %) the sentinel node was successfully removed. In 18 patients (22.8 %) a (micro)metastasis was found on pathologic examination. Confirmation ALND in 18 patients showed no axillary lymph node metastases. Aberrant drainage pathways were visualized in 58.9 % of the patients, significantly more frequently after a previous ALND (79.3 %) than after a previous SNB (25.0 %) (P < .0001). Overall, the result of this repeat SNB led to a change in the adjuvant treatment plan in 16.5 % of the patients with a successful repeat SNB.

Conclusions

Repeat SNB is technically feasible and provides reliable results in patients with locally recurrent breast cancer, leading to change in management in 1 of 6 patients.

Keywords

Sentinel Node Sentinel Node Biopsy Axillary Lymph Node Dissection Recurrent Breast Cancer Lymphatic Mapping 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

The authors thank the following clinicians for patient recruitment and providing the study data: Dr. R. F. Schmitz, Dr. J. E. de Vries, Mw. Dr. M. F. Ernst, Dr. F. W. C. van der Ent, Dr. B. van Ooijden, Dr. J. M. Klaase, Dr. J. A. van Essen, Dr. J. W. D. de Waard, Dr. F. C. den Boer, Dr. J. W. S. Merkus, Mw. Dr. M. B. E. Menke-Pluymers, Mw. Dr. C. M. E. Contant, Mw. J. P. J. Burgmans, Dr. H. W. P. M. Kemperman, Dr. B. C. Vrouenraets, Dr. P. H. J. M. Veldman, Dr. M. Smidt, and Dr. S. A. Koopal. 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 No. 2009-4466) for data registration and management.

Conflict of interest

The authors declare no conflicts of interest.

References

  1. 1.
    Nationaal Borstkanker Overleg Nederland (NABON). Richtlijn behandeling van het mammacarcinoom. 2008. Available at: www.oncoline.nl.
  2. 2.
    Kim T, Giuliano AE, Lyman GH. Lymphatic mapping and sentinel lymph node biopsy in early-staged breast carcinoma, a meta-analysis. Cancer. 2006;106:4–16.PubMedCrossRefGoogle Scholar
  3. 3.
    Naik AM, Fey J, Gemignani M, Heerdt A, Montgomery L, Petrek J, et al. 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. 2004;240:462–71.PubMedCrossRefGoogle Scholar
  4. 4.
    Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, et al. Sentinel-lymph-node biopsy as a staging procedure in breast cancer: update of a randomised controlled study. Lancet Oncol. 2006;7:983–90.PubMedCrossRefGoogle Scholar
  5. 5.
    Maaskant AJG, van de Poll-Franse LV, Voogd AC, Coebergh JWW, Tutein Nolthenius-Puylaert MCBJE, Nieuwenhuijzen GAP. Stage migration due to introduction of the sentinel node procedure: a population-based study. Breast Cancer Res Treat. 2009;113:173–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Edge SB, Niland JC, Bookman MA, Theriault RL, Ottesen R, Lepisto E, et al. Emergence of sentinel node biopsy in breast cancer as standard-of-care in academic comprehensive cancer centers. J Natl Cancer Inst. 2003;95:1514–21.PubMedCrossRefGoogle Scholar
  7. 7.
    Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227–32.PubMedCrossRefGoogle Scholar
  8. 8.
    Voogd AC, Nielsen M, Peterse JL, Blichert-Toft M, Bartelink H, Overgaard M, et al. 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. 2001;15:1688–97.Google Scholar
  9. 9.
    Recht A, Come SE, Troyan SL, Sadowski NL. Management of recurrent breast cancer. In: Harris J, Lippman M, Morrow M, Osborne CK, editors. Diseases of the breast. Philadelphia: Lippincott Williams & Wilkins; 2000. p.731–48.Google Scholar
  10. 10.
    Derkx F, Maaskant-Braat AJG, van der Sangen MJC, Nieuwenhuijzen GAP, van de Poll-Franse LV, Roumen RMH, et al. Staging and management of axillary lymph nodes in patients with local recurrence in the breast or chest wall after a previous negative sentinel node procedure. Eur J Surg Oncol. 2010;36:646–51.PubMedCrossRefGoogle Scholar
  11. 11.
    Schijven MP, Vingerhoets AJJM, Rutten HJT, Nieuwenhuijzen GAP, Roumen RMH, van Bussel ME, et al. Comparison of morbidity between axillary lymph node dissection and sentinel node biopsy. Eur J Surg Oncol. 2003;29:341–50.PubMedCrossRefGoogle Scholar
  12. 12.
    Roumen RMH, Kuijt GP, Liem IH. Lymphatic mapping and sentinel node harvesting in patients with recurrent breast cancer. Eur J Surg Oncol. 2006;32:1076–81.PubMedCrossRefGoogle Scholar
  13. 13.
    Port ER, Garcia-Etienne CA, Park J, Fey J, Borgen PI, Cody HS 3rd. Reoperative sentinel lymph node biopsy: a new frontier in the management of ipsilateral breast tumor recurrence. Ann Surg Oncol. 2007;14:2209–14.PubMedCrossRefGoogle Scholar
  14. 14.
    Intra M, Trifirò G, Galimberti V, Gentilini O, Rotmensz N, Veronesi P. Second axillary sentinel node biopsy for ipsilateral breast tumour recurrence. Br J Surg. 2007;94:1216–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Hermanek P, Sobin LH, editors. UICC TNM classification of malignant tumors. Berlin: Springer; 1987. p. 94–9.Google Scholar
  16. 16.
    Overgaard M, Hansen PS, Overgaard J, Rose C, Andersson M, Bach F, et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. N Engl J Med. 1997;337:949–55.PubMedCrossRefGoogle Scholar
  17. 17.
    Orr RK. The impact of prophylactic axillary node dissection on breast cancer survival—a Bayesian meta-analysis. Ann Surg Oncol. 1999;6:109–16.PubMedCrossRefGoogle Scholar
  18. 18.
    Giuliano AE, McCall L, Beitsch P, Whitworth PW, Blumencranz P, Leitch AM, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases. Ann Surg. 2010;252:426–33.PubMedGoogle Scholar
  19. 19.
    Giuliano AE, Hunt KK, Ballman KV, Beitsch PD, Whitworth PW, Blumencranz PW, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011;305:569–75.PubMedCrossRefGoogle Scholar
  20. 20.
    van Tienhoven G, Voogd AC, Peterse JL, Nielsen M, Andersen KW, Mignolet F, et al. on behalf of the EORTC Breast Cancer Cooperative Group and the Danish Breast Cancer Cooperative Group. Prognosis after treatment for loco-regional recurrence after mastectomy or breast conserving therapy in two randomized trials (EORTC 10801 and DBCG-82TM). Eur J Cancer. 1999;35:32–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Van der Sangen MJ, Coebergh JW, Roumen RM, Rutten HJ, Vreugdenhil G, Voogd AC. Detection, treatment, and outcome of isolated supraclavicular recurrence in 42 patients with invasive breast carcinoma. Cancer. 2003;98:11–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Voogd AC, van Oost FJ, Rutgers EJ, Elkhuizen PH, van Geel AN, Scheijmans LJ, et al. Long-term prognosis of patients with local recurrence after conservative surgery and radiotherapy for early breast cancer. Eur J Cancer. 2005;41:2637–44.PubMedCrossRefGoogle Scholar
  23. 23.
    Fisher B, Anderson S, Fisher ER, Redmond C, Wickerham DL, Wolmark N, et al. Significance of ipsilateral breast tumour recurrence after lumpectomy. Lancet. 1991;338:327–31.PubMedCrossRefGoogle Scholar
  24. 24.
    Clemons M, Danson S, Hamilton T, Goss P. Locoregionally recurrent breast cancer: incidence, risk factors and survival. Cancer Treat Rev. 2001;27:67–82.PubMedCrossRefGoogle Scholar
  25. 25.
    Borner M, Bacchi M, Goldhirsch A, Greiner R, Harder F, Castiglione M, et al. 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. 1994;12:2071–7.PubMedGoogle Scholar
  26. 26.
    Haylock BJ, Coppin CM, Jackson J, Basco VE, Wilson KS. Locoregional first recurrence after mastectomy: prospective cohort studies with and without immediate chemotherapy. Int J Radiat Oncol Biol Phys. 2000;46:355–62.PubMedCrossRefGoogle Scholar
  27. 27.
    Rauschecker H, Clarke M, Gatzemeier, Recht A. Systemic therapy for treating locoregional recurrence in women with breast cancer. Cochrane Database Syst Rev. 2001;(4):CD002195.Google Scholar
  28. 28.
    Karam A, Stempel M, Cody HS, Port ER. Reoperative sentinel lymph node biopsy after previous mastectomy. J Am Coll Surg. 2008;207:543–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Schrenk P, Tausch C, Wayand W. Lymphatic mapping in patients with primary or recurrent breast cancer following previous axillary surgery. Eur J Surg Oncol. 2008;34:851–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Grant RN, Tabah EJ, Adair FE. The surgical significance of the subareolar lymph plexus in cancer of the breast. Surgery. 1953;33:71–8.PubMedGoogle Scholar
  31. 31.
    Suami H, Pan W, Taylor GI. Historical review of breast lymphatic studies. Clin Anat. 2009;22:531–6.PubMedCrossRefGoogle Scholar
  32. 32.
    Suami H, Pan W, Mann GB, Taylor GI. The lymphatic anatomy of the breast and its implications for sentinel lymph node biopsy. Ann Surg Oncol. 2007;15:863–71.PubMedCrossRefGoogle Scholar
  33. 33.
    Lanitis S, Behranwala KA, Al-Mufti R, Hadjiminas D. Axillary metastatic disease as presentation of occult or contralateral breast cancer. Breast. 2009;18:225–7.PubMedCrossRefGoogle Scholar
  34. 34.
    Perre CI, Hoefnagel CA, Kroon BB, Zoetmulder FA, Rutgers EJ. Altered lymphatic drainage after lymphadenectomy of radiotherapy of the axilla in patients with breast cancer. Br J Surg. 1996;83:1258.PubMedCrossRefGoogle Scholar
  35. 35.
    Estourgie SH, Valdes Olmos RA, Nieweg OE, Hoefnagel CA, Rutgers EJT, Kroon BBR. Excision biopsy of breast lesions changes the pattern of lymphatic drainage. Br J Surg. 2007;94:1088–91.PubMedCrossRefGoogle Scholar
  36. 36.
    Boughey JC, Ross MI, Babiera GV, Bedrosian I, Feig BW, Hwang RF, et al. Sentinel lymph node surgery in locally recurrent breast cancer. Clin Breast Cancer. 2006;7:248–53.PubMedCrossRefGoogle Scholar
  37. 37.
    Dinan D, Nagle CE, Pettinga J. 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. 2005;190:614–7.PubMedCrossRefGoogle Scholar
  38. 38.
    Koizumi M, Koyama M, Tada K, Nishimura S, Miyagi Y, Makita M, et al. The feasibility of sentinel node biopsy in the previously treated breast. Eur J Surg Oncol. 2008;34:365–8.PubMedCrossRefGoogle Scholar
  39. 39.
    Taback B, Nguyen P, Hansen N, Edwards GK, Conway K, Giuliano AE. Sentinel lymph node biopsy for local recurrence of breast cancer after breast-conserving therapy. Ann Surg Oncol. 2006;13:1099–104.PubMedCrossRefGoogle Scholar
  40. 40.
    Tasevski R, Gogos AJ, Mann GB. Reoperative sentinel lymph node biopsy in ipsilateral breast cancer relapse. Breast. 2009;18:322–6.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • Adriana J. G. Maaskant-Braat
    • 1
    Email author
  • Rudi M. H. Roumen
    • 2
  • Adri C. Voogd
    • 3
    • 4
  • Rik Pijpers
    • 5
  • Ernest J. T. Luiten
    • 6
  • Emiel J. T. Rutgers
    • 7
  • Grard A. P. Nieuwenhuijzen
    • 1
  1. 1.Department of SurgeryCatharina HospitalEindhovenThe Netherlands
  2. 2.Department of SurgeryMáxima Medical CenterVeldhoven/EindhovenThe Netherlands
  3. 3.Department of Epidemiology, Faculty of Health Medicine and Life Sciences, Research Institute Growth and Development (GROW)Maastricht UniversityMaastrichtThe Netherlands
  4. 4.Eindhoven Cancer RegistryComprehensive Cancer Center SouthEindhovenThe Netherlands
  5. 5.Department of Nuclear MedicineBernard Verbeeten InstituteTilburgThe Netherlands
  6. 6.Department of SurgeryAmphia HospitalBredaThe Netherlands
  7. 7.Department of SurgeryThe Netherlands Cancer Institute and Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands

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