Top

Published in:

01-11-2005 | Original Articles

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

Authors: Mattia Intra, MD, Giuseppe Trifirò, MD, Giuseppe Viale, MD, FRCPath, Nicole Rotmensz, MSc, Oreste D. Gentilini, MD, Javier Soteldo, MD, Viviana Galimberti, MD, Paolo Veronesi, MD, Alberto Luini, MD, Giovanni Paganelli, MD, Umberto Veronesi, MD

Published in: Annals of Surgical Oncology | Issue 11/2005

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.

Veronesi U, Paganelli G, Viale G, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med 2003;349:546–53. CrossRef

Schwartz GF, Giuliano AE, Veronesi U. Proceedings of the consensus conference on the role of sentinel lymph node biopsy in carcinoma of the breast, April 19-22, 2001, Philadelphia, Pennsylvania. Cancer 2002;94:2542–51CrossRef

Fisher B, Redmond C, Poisson R, et al. Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 1989;320:822–8

Van Dongen JA, Bartelink H, Fentiman IS, et al. Randomized clinical trial to assess the value of breast-conserving therapy in stage I and II breast cancer, EORTC 10801 trial. J Natl Cancer Inst Monogr 1992;11:15–8

Salvadori B, Marubini E, Miceli R, et al. Reoperation for locally recurrent breast cancer in patients previously treated with conservative surgery. Br J Surg 1999;86:84–7. CrossRef

Burstein HJ, Polyak K, Wong JS, et al. Ductal carcinoma in situ of the breast. N Engl J Med 2004;350:1430–41CrossRef

Julien J-P, Bijker N, Fentiman IS, et al. Radiotherapy in breast-conserving treatment for ductal carcinoma in situ: first results of the EORTC randomised phase III trial 10853. Lancet 2000;355:528–33CrossRef

Fisher B, Dignam J, Wolmark N, et al. Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from the National Surgical Adjuvant Breast and Bowel Project B-17. J Clin Oncol 1998;16:441–52.

Mariani G, Erba P, Villa G, et al. Lymphoscintigraphic and intraoperative detection of the sentinel lymph node in breast cancer patients: the nuclear medicine perspective. J Surg Oncol 2004;85:112–22CrossRef

10.

Paganelli G, Luini A, Veronesi U. Radioguided occult lesion localization (ROLL) in breast cancer: maximizing efficacy, minimizing mutilation. Ann Oncol 2002;13:1839–40CrossRef

11.

Viale G, Sonzogni A, Pruneri G, et al. Histopathologic examination of axillary sentinel lymph nodes in breast carcinoma patients. J Surg Oncol 2004;85:123–8. CrossRef

12.

Intra M, Veronesi P, Mazzarol G, et al. Axillary sentinel lymph node biopsy in patients with pure ductal carcinoma in situ of the breast. Arch Surg 2003;138:309–13CrossRef

13.

Intra M, Zurrida S, Maffini F, et al. Sentinel lymph node metastasis in microinvasive breast cancer. Ann Surg Oncol 2003;10:1160–5. CrossRef

14.

Bedrosian I, Reynolds C, Mick R, et al. Accuracy of sentinel lymph node biopsy in patients with large primary breast tumors. Cancer 2000;88:2540–5CrossRef

15.

Olson JA, Fey J, Winawer J, et al. Sentinel lymphadenectomy accurately predicts nodal status in T2 breast cancer. J Am Coll Surg 2000;191:593–9. CrossRef

16.

Tousimis E, Van Zee KJ, Fey JV, et al. The accuracy of sentinel lymph node biopsy in multicentric and multifocal invasive breast cancers. J Am Coll Surg 2003;197:529–35CrossRef

17.

Breslin TM, Cohen L, Sahin A, et al. Sentinel lymph node biopsy is accurate after neoadjuvant chemotherapy for breast cancer. J Clin Oncol 2000;18:3480–6.

18.

Haigh PI, Hansen NM, Qi K, Giuliano AE. Biopsy method and excision volume do not affect success rate of subsequent sentinel lymph node dissection in breast cancer. Ann Surg Oncol 2000;7:21–7. CrossRef

19.

Port ER, Fey J, Gemignani ML, et al. Reoperative sentinel lymph node biopsy: a new option for patients with primary or locally recurrent breast carcinoma. J Am Coll Surg 2002;195:167–72. CrossRef

20.

Goyal A, Mansel RE. Multifocality and sentinel node biopsy in breast cancer. Eur J Surg Oncol 2004;30:3–4CrossRef

21.

Kumar R, Potenta S, Alavi A. Sentinel lymph node biopsy in multifocal and multicentric breast cancer. J Am Coll Surg 2004;198:674–6CrossRef

22.

Intra M, Rotmensz N, Viale G, Veronesi U. Re: Trends in the treatment of ductal carcinoma in situ of the breast. J Natl Cancer Inst 2004;96:1110–1

Title: Second Biopsy of Axillary Sentinel Lymph Node for Reappearing Breast Cancer After Previous Sentinel Lymph Node Biopsy
Authors: Mattia Intra, MD
Giuseppe Trifirò, MD
Giuseppe Viale, MD, FRCPath
Nicole Rotmensz, MSc
Oreste D. Gentilini, MD
Javier Soteldo, MD
Viviana Galimberti, MD
Paolo Veronesi, MD
Alberto Luini, MD
Giovanni Paganelli, MD
Umberto Veronesi, MD
Publication date: 01-11-2005
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 11/2005
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/ASO.2005.10.018

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 11/2005

Hepatic Resection at a Major Community-Based Teaching Hospital Can Result in Good Outcome

If at First or Second You Don’t Succeed: Mastectomy?

Breast Cancer: Presentation and Intervention in Women With Gastrointestinal Metastasis and Carcinomatosis

Society of Surgical Oncology Heritage Award: Introduction—Honoring Samuel Alonzo Wells, Jr., MD

The Second International Conference on Sentinel Node Biopsy in Mucosal Head and Neck Cancer

Metastatic Colorectal Carcinoma: Pushing the Surgical Envelope of Cure