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Second Biopsy of Axillary Sentinel Lymph Node for Reappearing Breast Cancer After Previous Sentinel Lymph Node Biopsy

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Abstract

Background

Sentinel lymph node biopsy (SLNB) is a safe and accurate axillary staging procedure for patients with primary operable breast cancer. An increasing proportion of these patients undergo breast-conserving surgery, and 5% to 15% will develop local relapses that necessitate reoperation. Although a previous SLNB is often considered a contraindication for a subsequent SLNB, few data support this concern.

Methods

Between January 2000 and June 2004, 79 patients who were previously treated at our institution with breast-conserving surgery and who had a negative SLNB for early breast cancer developed, during follow-up, local recurrence that was amenable to reoperation. Eighteen of these patients were offered a second SLNB because of a clinically negative axillary status an average of 26.1 months after the primary event.

Results

In all 18 patients (7 with ductal carcinoma-in-situ and 11 with invasive recurrences), preoperative lymphoscintigraphy showed an axillary sentinel lymph node, with a preoperative identification rate of 100%, and 1 or more SLNs (an average of 1.3 per patient) were surgically removed. Sentinel lymph node metastases were detected in two patients with invasive recurrence, and a complete axillary dissection followed. At a median follow up of 12.7 months, no axillary recurrences have occurred in patients who did not undergo axillary dissection.

Conclusions

Second SLNB after previous SLNB is technically feasible and likely effective in selected breast cancer patients. A larger population and longer follow-up are necessary to confirm these preliminary data.

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Authors and Affiliations

  1. Division of Breast Surgery, European Institute of Oncology, Via Ripamonti, 435, 20141, Milan, Italy

    Mattia Intra MD, Oreste D. Gentilini MD, Javier Soteldo MD, Viviana Galimberti MD, Paolo Veronesi MD, Alberto Luini MD & Umberto Veronesi MD

  2. Division of Nuclear Medicine, European Institute of Oncology, Via Ripamonti, 435, 20141, Milan, Italy

    Giuseppe Trifirò MD & Giovanni Paganelli MD

  3. Division of Pathology and Laboratory Medicine, European Institute of Oncology, Via Ripamonti, 435, 20141, Milan, Italy

    Giuseppe Viale MD, FRCPath

  4. University of Milan School of Medicine, Milan, Italy

    Giuseppe Viale MD, FRCPath & Paolo Veronesi MD

  5. Division of Epidemiology and Biostatistics, European Institute of Oncology, Via Ripamonti, 435, 20141, Milan, Italy

    Nicole Rotmensz MSc

Authors
  1. Mattia Intra MD
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  2. Giuseppe Trifirò MD
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  3. Giuseppe Viale MD, FRCPath
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  4. Nicole Rotmensz MSc
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  5. Oreste D. Gentilini MD
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  6. Javier Soteldo MD
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  7. Viviana Galimberti MD
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  8. Paolo Veronesi MD
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  9. Alberto Luini MD
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  10. Giovanni Paganelli MD
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  11. Umberto Veronesi MD
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Corresponding author

Correspondence to Mattia Intra MD.

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Intra, M., Trifirò, G., Viale, G. et al. Second Biopsy of Axillary Sentinel Lymph Node for Reappearing Breast Cancer After Previous Sentinel Lymph Node Biopsy. Ann Surg Oncol 12, 895–899 (2005). https://doi.org/10.1245/ASO.2005.10.018

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  • DOI: https://doi.org/10.1245/ASO.2005.10.018

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