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Published in: Breast Cancer Research and Treatment 3/2015

01-10-2015 | Clinical trial

Repeat sentinel node biopsy should be considered in patients with locally recurrent breast cancer

Authors: G. Vugts, A. J. G. Maaskant-Braat, A. C. Voogd, Y. E. A. van Riet, E. J. T. Luiten, E. J. Th. Rutgers, H. J. T. Rutten, R. M. H. Roumen, G. A. P. Nieuwenhuijzen

Published in: Breast Cancer Research and Treatment | Issue 3/2015

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Abstract

Most patients with locally recurrent breast cancer undergo axillary lymph node dissection (ALND). However, repeat sentinel node biopsy (SNB) could provide regional nodal staging and obviate the need for standard ALND. The Sentinel Node and Recurrent Breast Cancer (SNARB) study is a Dutch nationwide registration study conducted to determine feasibility, aberrant drainage rates, and clinical consequences of repeat SNB. A total of 536 patients with locally recurrent non-metastatic breast cancer underwent lymphatic mapping and repeat SNB in 29 Dutch hospitals. A repeat sentinel node (SN) was identified in 333 of 536 patients (62.1 %) and surgically harvested in 287 patients (53.5 %). Aberrant lymph drainage was observed in 180 (54.1 %) of the 333 patients, more often after previous ALND (81.9 %) than SNB (28.4 %; P < 0.001). In 230 patients (80.1 %), the retrieved SN was tumor negative; 17 SNs (5.9 %) contained a micrometastasis and 29 (10.1 %) a macrometastasis. Confirmation ALND in 31 repeat SN-negative patients revealed a macrometastasis in two patients (6.5 %). The negative predictive value (NPV) of repeat SNB was 93.6 %, and ALND was omitted in 109 of the 248 patients (44.0 %) with a negative repeat SN. In 29 of the 44 patients (63.0 %) with a positive SN, adjuvant treatment plans were altered based on the repeat SNB. Repeat SNB is a feasible procedure with a high NPV, leading to a change in management in a substantial proportion of patients. Therefore, repeat SNB should replace routine ALND and serve as the standard of care in recurrent breast cancer.
Literature
2.
go back to reference Lyman GH, Giuliano AE, Somerfield MR, Benson AB 3rd, Bodurka DC, Burstein HJ et al (2005) American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol 23(30):7703–7720CrossRefPubMed Lyman GH, Giuliano AE, Somerfield MR, Benson AB 3rd, Bodurka DC, Burstein HJ et al (2005) American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol 23(30):7703–7720CrossRefPubMed
3.
go back to reference Veronesi U, Paganelli G, Galimberti V, Viale G, Zurrida S, Bedoni M et al (1997) Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes. Lancet 349(9069):1864–1867CrossRefPubMed Veronesi U, Paganelli G, Galimberti V, Viale G, Zurrida S, Bedoni M et al (1997) Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes. Lancet 349(9069):1864–1867CrossRefPubMed
4.
go back to reference Giuliano AE, Dale PS, Turner RR, Morton DL, Evans SW, Krasne DL (1995) Improved axillary staging of breast cancer with sentinel lymphadenectomy. Ann Surg 222(3):394–399 (discussion 9–401) PubMedCentralCrossRefPubMed Giuliano AE, Dale PS, Turner RR, Morton DL, Evans SW, Krasne DL (1995) Improved axillary staging of breast cancer with sentinel lymphadenectomy. Ann Surg 222(3):394–399 (discussion 9–401) PubMedCentralCrossRefPubMed
5.
go back to reference Kim T, Giuliano AE, Lyman GH (2006) Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a metaanalysis. Cancer 106(1):4–16CrossRefPubMed Kim T, Giuliano AE, Lyman GH (2006) Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a metaanalysis. Cancer 106(1):4–16CrossRefPubMed
6.
go back to reference Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V et al (2006) Sentinel-lymph-node biopsy as a staging procedure in breast cancer: update of a randomised controlled study. Lancet Oncol 7(12):983–990CrossRefPubMed Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V et al (2006) Sentinel-lymph-node biopsy as a staging procedure in breast cancer: update of a randomised controlled study. Lancet Oncol 7(12):983–990CrossRefPubMed
7.
go back to reference Maaskant AJ, van de Poll-Franse LV, Voogd AC, Coebergh JW, Tutein Nolthenius-Puylaert MC, Nieuwenhuijzen GA (2009) Stage migration due to introduction of the sentinel node procedure: a population-based study. Breast Cancer Res Treat 113(1):173–179CrossRefPubMed Maaskant AJ, van de Poll-Franse LV, Voogd AC, Coebergh JW, Tutein Nolthenius-Puylaert MC, Nieuwenhuijzen GA (2009) Stage migration due to introduction of the sentinel node procedure: a population-based study. Breast Cancer Res Treat 113(1):173–179CrossRefPubMed
8.
go back to reference Edge SB, Niland JC, Bookman MA, Theriault RL, Ottesen R, Lepisto E et al (2003) Emergence of sentinel node biopsy in breast cancer as standard-of-care in academic comprehensive cancer centers. J Natl Cancer Inst 95(20):1514–1521CrossRefPubMed Edge SB, Niland JC, Bookman MA, Theriault RL, Ottesen R, Lepisto E et al (2003) Emergence of sentinel node biopsy in breast cancer as standard-of-care in academic comprehensive cancer centers. J Natl Cancer Inst 95(20):1514–1521CrossRefPubMed
9.
go back to reference Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A et al (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. New Engl J Med 347(16):1227–1232CrossRefPubMed Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A et al (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. New Engl J Med 347(16):1227–1232CrossRefPubMed
10.
go back to reference Voogd AC, Nielsen M, Peterse JL, Blichert-Toft M, Bartelink H, Overgaard M 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 19(6):1688–1697PubMed Voogd AC, Nielsen M, Peterse JL, Blichert-Toft M, Bartelink H, Overgaard M 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 19(6):1688–1697PubMed
11.
go back to reference Wapnir IL, Anderson SJ, Mamounas EP, Geyer CE Jr, Jeong JH, Tan-Chiu E et al (2006) Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in five National Surgical Adjuvant Breast and Bowel Project node-positive adjuvant breast cancer trials. J Clin Oncol 24(13):2028–2037CrossRefPubMed Wapnir IL, Anderson SJ, Mamounas EP, Geyer CE Jr, Jeong JH, Tan-Chiu E et al (2006) Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in five National Surgical Adjuvant Breast and Bowel Project node-positive adjuvant breast cancer trials. J Clin Oncol 24(13):2028–2037CrossRefPubMed
12.
go back to reference Recht A, Come SE, Troyan SL, Sadowski NL (2000) Management of recurrent breast cancer. In: Harris J, Lippman M, Morrow M, Osborne CK (eds) Diseases of the breast. Lippincott Williams & Wilkins, Philadelphia, pp 731–748 Recht A, Come SE, Troyan SL, Sadowski NL (2000) Management of recurrent breast cancer. In: Harris J, Lippman M, Morrow M, Osborne CK (eds) Diseases of the breast. Lippincott Williams & Wilkins, Philadelphia, pp 731–748
13.
go back to reference Derkx F, Maaskant-Braat AJ, van der Sangen MJ, Nieuwenhuijzen GA, van de Poll-Franse LV, Roumen RM et al (2010) 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 36(7):646–651CrossRefPubMed Derkx F, Maaskant-Braat AJ, van der Sangen MJ, Nieuwenhuijzen GA, van de Poll-Franse LV, Roumen RM et al (2010) 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 36(7):646–651CrossRefPubMed
14.
go back to reference Schijven MP, Vingerhoets AJ, Rutten HJ, Nieuwenhuijzen GA, Roumen RM, van Bussel ME et al (2003) Comparison of morbidity between axillary lymph node dissection and sentinel node biopsy. Eur J Surg Oncol 29(4):341–350CrossRefPubMed Schijven MP, Vingerhoets AJ, Rutten HJ, Nieuwenhuijzen GA, Roumen RM, van Bussel ME et al (2003) Comparison of morbidity between axillary lymph node dissection and sentinel node biopsy. Eur J Surg Oncol 29(4):341–350CrossRefPubMed
15.
go back to reference Roumen RM, Kuijt GP, Liem IH (2006) Lymphatic mapping and sentinel node harvesting in patients with recurrent breast cancer. Eur J Surg Oncol 32(10):1076–1081CrossRefPubMed Roumen RM, Kuijt GP, Liem IH (2006) Lymphatic mapping and sentinel node harvesting in patients with recurrent breast cancer. Eur J Surg Oncol 32(10):1076–1081CrossRefPubMed
16.
go back to reference 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(8):2209–2214CrossRefPubMed 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(8):2209–2214CrossRefPubMed
17.
go back to reference Intra M, Trifiro G, Galimberti V, Gentilini O, Rotmensz N, Veronesi P (2007) Second axillary sentinel node biopsy for ipsilateral breast tumour recurrence. Br J Surg 94(10):1216–1219CrossRefPubMed Intra M, Trifiro G, Galimberti V, Gentilini O, Rotmensz N, Veronesi P (2007) Second axillary sentinel node biopsy for ipsilateral breast tumour recurrence. Br J Surg 94(10):1216–1219CrossRefPubMed
18.
go back to reference Intra M, Viale G, Vila J, Grana CM, Toesca A, Gentilini O et al (2014) Second axillary sentinel lymph node biopsy for breast tumor recurrence: experience of the European Institute of Oncology. Ann Surg Oncol 22:2372–2377CrossRefPubMed Intra M, Viale G, Vila J, Grana CM, Toesca A, Gentilini O et al (2014) Second axillary sentinel lymph node biopsy for breast tumor recurrence: experience of the European Institute of Oncology. Ann Surg Oncol 22:2372–2377CrossRefPubMed
19.
go back to reference Maaskant-Braat AJ, Roumen RM, Voogd AC, Pijpers R, Luiten EJ, Rutgers EJ et al (2013) Sentinel node and recurrent breast cancer (SNARB): results of a nationwide registration study. Ann Surg Oncol 20(2):620–626CrossRefPubMed Maaskant-Braat AJ, Roumen RM, Voogd AC, Pijpers R, Luiten EJ, Rutgers EJ et al (2013) Sentinel node and recurrent breast cancer (SNARB): results of a nationwide registration study. Ann Surg Oncol 20(2):620–626CrossRefPubMed
20.
go back to reference Maaskant-Braat AJ, Voogd AC, Roumen RM, Nieuwenhuijzen GA (2013) Repeat sentinel node biopsy in patients with locally recurrent breast cancer: a systematic review and meta-analysis of the literature. Breast Cancer Res Treat 138(1):13–20CrossRefPubMed Maaskant-Braat AJ, Voogd AC, Roumen RM, Nieuwenhuijzen GA (2013) Repeat sentinel node biopsy in patients with locally recurrent breast cancer: a systematic review and meta-analysis of the literature. Breast Cancer Res Treat 138(1):13–20CrossRefPubMed
21.
go back to reference Suami H, Pan WR, Taylor GI (2009) Historical review of breast lymphatic studies. Clin Anat 22(5):531–536CrossRefPubMed Suami H, Pan WR, Taylor GI (2009) Historical review of breast lymphatic studies. Clin Anat 22(5):531–536CrossRefPubMed
22.
go back to reference Grant RN, Tabah EJ, Adair FE (1953) The surgical significance of the subareolar symph plexus in cancer of the breast. Surgery 33(1):71–78PubMed Grant RN, Tabah EJ, Adair FE (1953) The surgical significance of the subareolar symph plexus in cancer of the breast. Surgery 33(1):71–78PubMed
23.
go back to reference Suami H, Pan WR, Mann GB, Taylor GI (2008) The lymphatic anatomy of the breast and its implications for sentinel lymph node biopsy: a human cadaver study. Ann Surg Oncol 15(3):863–871PubMedCentralCrossRefPubMed Suami H, Pan WR, Mann GB, Taylor GI (2008) The lymphatic anatomy of the breast and its implications for sentinel lymph node biopsy: a human cadaver study. Ann Surg Oncol 15(3):863–871PubMedCentralCrossRefPubMed
24.
go back to reference Mukesh MB, Harris E, Collette S, Coles CE, Bartelink H, Wilkinson J et al (2013) Normal tissue complication probability (NTCP) parameters for breast fibrosis: pooled results from two randomised trials. Radiother Oncol 108(2):293–298CrossRefPubMed Mukesh MB, Harris E, Collette S, Coles CE, Bartelink H, Wilkinson J et al (2013) Normal tissue complication probability (NTCP) parameters for breast fibrosis: pooled results from two randomised trials. Radiother Oncol 108(2):293–298CrossRefPubMed
25.
go back to reference Borger JH, Kemperman H, Smitt HS, Hart A, van Dongen J, Lebesque J et al (1994) Dose and volume effects on fibrosis after breast conservation therapy. Int J Radiat Oncol Biol Phys 30(5):1073–1081CrossRefPubMed Borger JH, Kemperman H, Smitt HS, Hart A, van Dongen J, Lebesque J et al (1994) Dose and volume effects on fibrosis after breast conservation therapy. Int J Radiat Oncol Biol Phys 30(5):1073–1081CrossRefPubMed
26.
go back to reference Boughey JC, Ross MI, Babiera GV, Bedrosian I, Feig BW, Hwang RF et al (2006) Sentinel lymph node surgery in locally recurrent breast cancer. Clin Breast Cancer 7(3):248–253CrossRefPubMed Boughey JC, Ross MI, Babiera GV, Bedrosian I, Feig BW, Hwang RF et al (2006) Sentinel lymph node surgery in locally recurrent breast cancer. Clin Breast Cancer 7(3):248–253CrossRefPubMed
27.
go back to reference 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(4):614–617CrossRefPubMed 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(4):614–617CrossRefPubMed
28.
go back to reference Koizumi M, Koyama M, Tada K, Nishimura S, Miyagi Y, Makita M et al (2008) The feasibility of sentinel node biopsy in the previously treated breast. Eur J Surg Oncol 34(4):365–368CrossRefPubMed Koizumi M, Koyama M, Tada K, Nishimura S, Miyagi Y, Makita M et al (2008) The feasibility of sentinel node biopsy in the previously treated breast. Eur J Surg Oncol 34(4):365–368CrossRefPubMed
29.
go back to reference 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(8):1099–1104CrossRefPubMed 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(8):1099–1104CrossRefPubMed
30.
go back to reference Louis-Sylvestre C, Clough K, Asselain B, Vilcoq JR, Salmon RJ, Campana F et al (2004) Axillary treatment in conservative management of operable breast cancer: dissection or radiotherapy? Results of a randomized study with 15 years of follow-up. J Clin Oncol 22(1):97–101CrossRefPubMed Louis-Sylvestre C, Clough K, Asselain B, Vilcoq JR, Salmon RJ, Campana F et al (2004) Axillary treatment in conservative management of operable breast cancer: dissection or radiotherapy? Results of a randomized study with 15 years of follow-up. J Clin Oncol 22(1):97–101CrossRefPubMed
31.
go back to reference Fisher B, Wolmark N, Redmond C, Deutsch M, Fisher ER (1981) Findings from NSABP Protocol No. B-04: comparison of radical mastectomy with alternative treatments. II. The clinical and biologic significance of medial-central breast cancers. Cancer 48(8):1863–1872CrossRefPubMed Fisher B, Wolmark N, Redmond C, Deutsch M, Fisher ER (1981) Findings from NSABP Protocol No. B-04: comparison of radical mastectomy with alternative treatments. II. The clinical and biologic significance of medial-central breast cancers. Cancer 48(8):1863–1872CrossRefPubMed
32.
go back to reference Fisher B, Jeong JH, Anderson S, Bryant J, Fisher ER, Wolmark N (2002) Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. New Engl J Med 347(8):567–575CrossRefPubMed Fisher B, Jeong JH, Anderson S, Bryant J, Fisher ER, Wolmark N (2002) Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. New Engl J Med 347(8):567–575CrossRefPubMed
33.
go back to reference van Tienhoven G, Voogd AC, Peterse JL, Nielsen M, Andersen KW, Mignolet F et al (1999) Prognosis after treatment for loco-regional recurrence after mastectomy or breast conserving therapy in two randomised trials (EORTC 10801 and DBCG-82TM). EORTC Breast Cancer Cooperative Group and the Danish Breast Cancer Cooperative Group. Eur J Cancer 35(1):32–38CrossRefPubMed van Tienhoven G, Voogd AC, Peterse JL, Nielsen M, Andersen KW, Mignolet F et al (1999) Prognosis after treatment for loco-regional recurrence after mastectomy or breast conserving therapy in two randomised trials (EORTC 10801 and DBCG-82TM). EORTC Breast Cancer Cooperative Group and the Danish Breast Cancer Cooperative Group. Eur J Cancer 35(1):32–38CrossRefPubMed
34.
go back to reference Voogd AC, van Oost FJ, Rutgers EJ, Elkhuizen PH, van Geel AN, Scheijmans LJ et al (2005) Long-term prognosis of patients with local recurrence after conservative surgery and radiotherapy for early breast cancer. Eur J Cancer 41(17):2637–2644CrossRefPubMed Voogd AC, van Oost FJ, Rutgers EJ, Elkhuizen PH, van Geel AN, Scheijmans LJ et al (2005) Long-term prognosis of patients with local recurrence after conservative surgery and radiotherapy for early breast cancer. Eur J Cancer 41(17):2637–2644CrossRefPubMed
35.
go back to reference Aebi S, Gelber S, Anderson SJ, Lang I, Robidoux A, Martin M et al (2014) Chemotherapy for isolated locoregional recurrence of breast cancer (CALOR): a randomised trial. Lancet Oncol 15(2):156–163PubMedCentralCrossRefPubMed Aebi S, Gelber S, Anderson SJ, Lang I, Robidoux A, Martin M et al (2014) Chemotherapy for isolated locoregional recurrence of breast cancer (CALOR): a randomised trial. Lancet Oncol 15(2):156–163PubMedCentralCrossRefPubMed
36.
go back to reference van der Sangen MJ, Poortmans PM, Scheepers SW, Lemaire BM, van Berlo CL, Tjan-Heijnen VC et al (2013) Prognosis following local recurrence after breast conserving treatment in young women with early breast cancer. Eur J Surg Oncol 39(8):892–898CrossRefPubMed van der Sangen MJ, Poortmans PM, Scheepers SW, Lemaire BM, van Berlo CL, Tjan-Heijnen VC et al (2013) Prognosis following local recurrence after breast conserving treatment in young women with early breast cancer. Eur J Surg Oncol 39(8):892–898CrossRefPubMed
37.
go back to reference van der Sangen MJ, van de Poll-Franse LV, Roumen RM, Rutten HJ, Coebergh JW, Vreugdenhil G et al (2006) The prognosis of patients with local recurrence more than five years after breast conservation therapy for invasive breast carcinoma. Eur J Surg Oncol 32(1):34–38CrossRefPubMed van der Sangen MJ, van de Poll-Franse LV, Roumen RM, Rutten HJ, Coebergh JW, Vreugdenhil G et al (2006) The prognosis of patients with local recurrence more than five years after breast conservation therapy for invasive breast carcinoma. Eur J Surg Oncol 32(1):34–38CrossRefPubMed
Metadata
Title
Repeat sentinel node biopsy should be considered in patients with locally recurrent breast cancer
Authors
G. Vugts
A. J. G. Maaskant-Braat
A. C. Voogd
Y. E. A. van Riet
E. J. T. Luiten
E. J. Th. Rutgers
H. J. T. Rutten
R. M. H. Roumen
G. A. P. Nieuwenhuijzen
Publication date
01-10-2015
Publisher
Springer US
Published in
Breast Cancer Research and Treatment / Issue 3/2015
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI
https://doi.org/10.1007/s10549-015-3571-4

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