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Annals of Surgical Oncology

, Volume 23, Issue 3, pp 744–748 | Cite as

Reoperative Sentinel Lymph Node Biopsy is Feasible for Locally Recurrent Breast Cancer, But is it Worthwhile?

  • Stacy Ugras
  • Cindy Matsen
  • Anne Eaton
  • Michelle Stempel
  • Monica Morrow
  • Hiram S. CodyIIIEmail author
Breast Oncology

Abstract

Introduction

Reoperative sentinel lymph node biopsy (SLNB) is feasible in patients with local recurrence (LR) of invasive breast cancer but it remains unclear if this procedure affects either treatment or outcome. In this study, we ask whether axillary restaging (vs. none) at the time of LR affects the rate of subsequent events: axillary failure (AF), non-axillary recurrence (NAR), distant metastasis, or death.

Methods

We queried our institutional database to identify patients treated surgically for invasive breast cancer with a negative SLNB (1997–2000) who developed ipsilateral breast or chest wall recurrence as a first event. We excluded those with gross nodal disease at the time of LR. The cumulative incidence of subsequent events was estimated using competing risks methodology.

Results

Of 1527 patients with negative SLN at initial surgery, 83 had an ipsilateral breast (79) or chest wall recurrence (4) with clinically negative regional nodes; 47 (57 %) were treated with and 36 (43 %) without axillary surgery. Primary tumor characteristics were similar between groups, although time to LR was shorter in the no axillary surgery group (median 3.4 vs. 6.5 years; p < 0.05). All patients in the axillary surgery group and 94 % of patients in the no axillary surgery group had surgical excision of their LR, and the use of subsequent radiation and systemic therapy was similar between groups. At a median follow-up of 4.2 years from the time of LR, the rates of AF, NAR, distant metastasis and death were low and did not differ between groups.

Conclusions

Among breast cancer patients with LR and clinically negative nodes, our results question the value of axillary restaging but invite confirmation in larger patient cohorts. Since randomized trials support the value of systemic therapy for all patients with invasive LR, reoperative SLNB, although feasible, may not be necessary.

Keywords

Local Recurrence Sentinel Lymph Node Biopsy Axillary Lymph Node Dissection Ipsilateral Breast Tumor Recurrence Negative Sentinel Lymph Node Biopsy 
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

Disclosures

Stacy Ugras, Cindy Matsen, Anne Eaton, Michelle Stempel, Monica Morrow, and Hiram S. Cody III have no disclosures to report. This study was funded in part by the Breast Cancer Alliance and National Institutes of Health/National Cancer Institute Cancer Center Support Grant P30 CA008748.

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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Stacy Ugras
    • 1
  • Cindy Matsen
    • 1
    • 2
  • Anne Eaton
    • 3
  • Michelle Stempel
    • 1
  • Monica Morrow
    • 1
  • Hiram S. CodyIII
    • 1
    Email author
  1. 1.Breast Service, Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Department of Surgery, Huntsman Cancer HospitalUniversity of UtahSalt Lake CityUSA
  3. 3.Department of Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkUSA

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