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Axillary Recurrence After a Negative Sentinel NodeBiopsy for Breast Cancer: Incidence and Clinical Significance

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Abstract

Background

Sentinel lymph node biopsy (SLNB) carries the inherent risk of approximately 5% false-negative sampling. Undetected tumor-positive nodes of clinical importance are those that lead to axillary recurrence. This survey aims at clarifying the extent of this problem in current practice and literature.

Methods

In a regional teaching hospital, 696 consecutive breast cancer patients underwent SLNB between January 1998 and July 2003, and data were entered in a prospective database. PubMed and the Cochrane library were searched for a systematic review of the literature. Thirteen studies dealt with the follow-up of a cohort of sentinel lymph node (SLN)-negative patients or presented a case report.

Results

The SLN identification rate was 97.1%. The SLN was tumor free in 439 (65%) of the 676 patients. After a median follow-up of 26 months, axillary recurrence was detected in 2 of 439 patients 4 and 27 months after the SLNB. The incidence of clinically apparent false-negative SLNB is .46%. The systematic review resulted in 3184 SLNB-negative patients with a median follow-up of 25 months. Axillary recurrence occurred in eight patients after a median of 21 months. The axillary recurrence rate in the literature is .25%. One third of these patients present with synchronous systemic metastases.

Conclusions

Axillary recurrences after a negative SLNB occur, but at a much lower rate than would be expected on the basis of historical figures and the false-negative SLN findings. The natural history of axillary relapse after negative SLNB resembles the locoregional recurrence of breast cancer.

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Authors and Affiliations

  1. Department of Surgical Oncology, C22, Canisius Wilhelmina Hospital, PO Box 9015, 6500, GS Nijmegen, The Netherlands

    Marjolein L. Smidt MD, Caroline M. M. Janssen MD, Deborah M. Kuster MD, Erik D. M. Bruggink MD, PhD & Luc J. A. Strobbe MD, PhD

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  1. Marjolein L. Smidt MD
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  2. Caroline M. M. Janssen MD
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  3. Deborah M. Kuster MD
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  4. Erik D. M. Bruggink MD, PhD
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  5. Luc J. A. Strobbe MD, PhD
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Correspondence to Marjolein L. Smidt MD.

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Smidt, M.L., Janssen, C.M.M., Kuster, D.M. et al. Axillary Recurrence After a Negative Sentinel NodeBiopsy for Breast Cancer: Incidence and Clinical Significance. Ann Surg Oncol 12, 29–33 (2005). https://doi.org/10.1007/s10434-004-1166-0

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